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• <br /> 813 - 780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received A v�- y 0 Phone Contact for Permit I � W <br /> IUI <br /> Owner's Name 4zk h 2 14 1 Owner's Phone Number 1, j 1 7S 2 - I I9�a(� Z1 <br /> Owner's Address 1 9 3 6 %/U u <br /> Fee Simple Titleholder Name I ( Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> ''.,+ �Xx„✓.°' x>""" k`+' s1:°`!' aZh#'#° YZa' 6`. r` .4e.3?.+r`;S.YA.�fri'Fr'F:.i+E 4, s. 4:;;'. r:: iSr)+ N. ex "3R`.".S'+3.:`(,2,.kr.:dYw4.l kay s =.ie .1+ °a..: '�.. '£ s7° isf? KJ. ?l�X».-' 2'., k' Y: dFF: S^ m„ rria.""`+'°.,'.^ Y'°`.:4k':',.3kd°i"`{£d";•':'. <br /> Job Address �/7///- Lot # I <br /> Sub Division I I Parcel # <br /> ;+?>w'w"f.*+'.ruT at.:[a._'«;k3>`rf.�:,'- c,`�x.0 rx .,...x:?.3,.r✓[,_.s..<S. ».,...x �, ..r...3:a ^�'::d..�t��.?#'.. ?4s7,".,.;" Irx:. �rx:==±» ra'.: a*,. xi_,: 3;:; ::a:.a5} °c3 »f= *..z,o",kcxa`°,. .t�,e'. ,. r§s:..rm;Y.�,r..nPr <br /> E Bio-Hazard Waste Storage - ANNUAL Hazardous Material (Tier II or RQ Facility) ANNUAL . <br /> El Comm Exhaust Kitchen Hood /Duct ED Hood Installation <br /> Controlled Bum = LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw = LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw ED Places of Assembly- ANNUAL / 1 <br /> El Fire Protection Maintenance - ANNUAL = Recreational Burn f ,G/ // ! <br /> rY EMU (:T✓� Other ° '/ ,- <br /> Sprinkler E ❑ ❑ ❑ I I n Sparklers <br /> (-- ❑ ❑ Sprinkler System Installations - -- <br /> Fire Alarm � ❑ I l <br /> Hood Cleaning El ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) <br /> Hood Suppression ❑ K ❑ I 1 El Torch Roofing/Tar Kettle <br /> Fire Alarm Installation [] Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> 7 Other: I I <br /> Contractor Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I I License # I <br /> OTHER Co /II At c. /14 / i L /4 G 6:... Co Company � I <br /> Signature . Registered (. 1 N Fee Current I Y / N <br /> 4. Address C'�� License# /,I / 0 V <br /> "d , r ., <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 /> • <br />