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ggqq 0 * 6 I �q <br /> 813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 1 Phone Contact for Permit ��3--2 L 5 or) <br /> Owner's Name I ( - l - lrl `PS� f` �/ ly C. 1 Owner's Phone Number q� 5 I 1 37 <br /> [ , I 1 <br /> Owner's Address I T'Z l�"l� t Q )C. w e. -SQ <br /> L ( C rl 1 0 c. C.-4, 4 rc & At - C . rnQ ( „ , 1?-r ,� (& j V t <br /> Fee Simple Titleholder Name I Titleholder Phone Number 1 I / 1 1 <br /> Fee Simple Titleholder Address I <br /> / ' �'" � , �/ _ <br /> Job Address I — 1 c U q i) r lti Z-e p ■ IN lit I S FL, 33s'ZI Lot # <br /> Sub Division I I Parcel # 134'2J-ooto-.,00L X0-d4Db b <br /> El Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood /Duct I Hood Installation <br /> El Controlled Bum n LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw L._J LP /Natural Gas - ANNUAL Sale <br /> El Emergency Generator > 30 kw Places of Assembly- ANNUAL <br /> 0 Fire Protection Maintenance - ANNUAL El Recreational Burn <br /> IQtrlyl ISemiI Will <br /> Sprinkler n ❑ ❑ ❑ I Sparklers <br /> Fire Alarm 0 ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ I , 0 Standpipes (Sprinkler Sys) <br /> Hood Suppression TI ❑ ❑ ❑ I I n Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation Ei Waste Tire Storage ANNUAL <br /> L1 Fire Pumps <br /> R Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> 0 Other: I I <br /> rn:. _. . .k n. 4.. grA. ,.,3, y.. . ... 4:€ '' ,..eat r''" MOW?* . ,nr.` - ,_- ..,.4'"a4:.. >. ..AIASI V; <br /> Contractor A� ) D Signat ure k't Company <br /> (� / , N YI K r / - I Registered Y / N I Fee Current ( Y / N <br /> Address ( I License # <br /> ELECTRICIAN Company ' <br /> Signature Registered I Y/ N I Fee Current I Y/ N I <br /> Address ( I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address ( I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <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 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />