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813-780 -0020 City of.Zephyrhills Fax - 813-780-0021 <br /> - Permit Application <br /> Date Received 0 Phone Contact for Permit <br /> Owner's Name pY t (C I ,, // t irr(U r .) -I Y� J Owner's Phone Number <br /> . <br /> Owner's Address )C71 "'l O ►{V1` -Leek Y i ' 2 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address ML-V ) ;,,. Fr Pi 4C e ht Y h t I k �C i � 2. Lot# <br /> Sub Division <br /> 1 Parcel # I I "Z 10 - LI • WJ0 - 163nO ` dIL.a <br /> n Bio- Hazard Waste Storage -.ANNUAL I - I Fumigation Tent . <br /> I Comm Exhaust Kitchen Hood/Duct pi Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I] Hood Installation <br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 17 Emergency Generator> 30 kw I 1 LP /Natural Gas - ANNUAL Sale <br /> lilt <br /> Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> • Lt�►7 semi) GLlit Mall <br /> Y e s SprinkleL_. ___ n 1 I Recreational Bum <br /> G ire Alarm ■ ❑ ■ M Sparklers <br /> - ... eaning J ] ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ I 1 [I Standpipes (Sprinkler Sys) <br /> I-I Fire Alarm Installation {-7 Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL f .1 Valuation of Project <br /> I I Fuel Tanks <br /> Other: I I <br /> Contractor ' Company C P re 1Q I c i IT i Rry.0 i nC_ • <br /> Signature Ai d �%V ik -,1 1� J Registered N Fee Current N <br /> Address I license # I EF corn I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address License # ( I <br /> PLUMBER Company I <br /> Signature ( Registered Y / N I Fee Current I Y / N .. I <br /> Address I License # I <br /> MECHANICAL Company <br /> Signature . Registered Y / N j Fee Current I Y / N , <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract wfth 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 />