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813-7 0 -0020 City of Zephyrhills Fire Fax - 813-780 -0021 <br /> Permit Application <br /> Date Received 1 ( e Contact ontact for Permit <br /> Owner's Name f - ft-r1" LPtJ .6 n (� Z.& 1 li\\-1 A A ( 1( S Owner's Phone Number <br /> Owner's Address SrZ- g�rty 0 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ' 'N L VAC �`3 mt.t:: € WAAaa".:r ",. & �L OSARFA E aM & 5' kEr.?' f y zAre F: • .. .., X11 . m a. r.:::lo , < .,wr „° « <br /> Job Address l Z 2 47rJ 4-X ' Lot # <br /> Sub Division ! Parcel # <br /> - <.°.xw. esuYY�; sP.k.Ka.:iawiv . . .u� ,x , i.. M.3roa`r <br /> I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum n Hood Installation <br /> I - I Emergency Generator < 30 kw ( LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw 1 I LP /Natural Gas - ANNUAL Sale <br /> 7 Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> l(ttriyl Semi Fri Other <br /> Sprinkler n ❑ ❑ ❑ 1 1 Recreational Bum <br /> Fire Alarm 1—I ❑ ❑ ❑ 1 1 ri Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I 1T Sprinkler System Installations <br /> Hood Suppression fr ❑ -1? ❑ I I 17 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I-I Fire Pumps r---1 Waste Tire Storage ANNUAL <br /> I Fire Works <br /> n Flammable Application- ANNUAL I Valuation of Project <br /> El Fuel Tanks <br /> Il O . -r: 1 <br /> . nam:.,. ._..m..'s.,F2 ':. °x"a ' ,. IM INIM..cMIKVS"*;I €!.. VWX a tsIa,'a'., ,... Z.x.... ',...mt .tr n .cs ...z:. l..SAM2 u1.10/ :;e"... ' ,- mit&m .A mHz egym..:. Mm <br /> Contractor i C.t f ' Company C cri Pt -67e- PK-CTI -LTA O' <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address <br /> ( r License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I License # I <br /> PLUMBER Company ( <br /> Signature Registered ` Y / N 1 Fee Current I Y / N I <br /> Address ( I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address I License # I <br /> OTHER Company I <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address ( License # I <br /> Dit ec tions: ons: <br /> r <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 />