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813 -780 -0020 City of.Zephyrhills-Fire Fax- 813-780 -0021 <br /> rl ✓ Permit Application // ff <br /> Date Received q Phone Contact for Permit � F)2 <br /> Q \, , v •`\■- Owner's Phone Number • <br /> Owner's Name ` � � � v / � I,, cc c:17 �Z I 1 <br /> Owner's Address ��� vkh, k- t_Q-' L k Ph l.' i' hl I �I) I .17r) - - 5 l 2 <br /> Fee Simple Titleholder Name <br /> J ! Titleholder Phone Number <br /> I <br /> Fee Simple Titleholder Address 1 <br /> Job Address (G 1IS S +h 3t)ciL 7 U <br /> � j,i1_a (15,) 1? 5:!/; ) }-J Lot <br /> Sub Division 1 I Parcel # UL Lo Z, I (I( /r16 CMG H CJ i t <br /> n Bio- Hazard Waste Storage ANNUAL I 1 Fumigation Tent . <br /> Comm Exhaust Kitchen Hood/Duct {-1 Hazardous Material (Tier H or RQ Facility NNUALL /} <br /> 1 1 Controlled Bum n Hood Installation .9 (15/ <br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL _ <br /> t"i!r <br /> ❑ ] I Dtner 1 I n / li Sprinkler ❑ Recreational Bum _ <br /> 1 _ <br /> Fire Alarm ❑ ❑ IV I . 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Instattat ns <br /> Hood Suppression El ❑ ❑ ❑ I ( I I Standpipes (Sprinkler Sys) - - --- <br /> I I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> FT Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works • <br /> I ; i Flammable Application- ANNUAL • ) Valuation of Project <br /> I I Fuel Tanks <br /> El Othe • I <br /> Contractor Company CO-y) n'> C C , 0_1 r , r r' ` CbrnmVh CG�r� 05 � Int I <br /> Signature ,�i ��I� <br /> 1 • Registered / N Fee Current Y/ N <br /> Address I 1 I License # I L k- OOOO 185 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address 1 I License # I <br /> MECHANICAL Company I <br /> Signature . Registered Y/ N I Fee Current I Y/ N I <br /> Address I 1 License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address <br /> License <br /> Directions: • <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 clays for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />