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i <br /> 813-780 -0020 City of Zephyrhills Fire /0 o 5 Fax -813- 780 -0021 <br /> Permit Application r <br /> • <br /> Date Received I V 09 43 - 17 1 Phone P ermit / . . M <br /> Contact for P <br /> Owner's Name - 1/21,- t L4yw u - e "' - 7 i rid T- Owner's Phone Number '/3 7 1 Qq d <br /> Owner's Address 37 y! 'DA u5 - <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> "*x. ,.aS ...i Wite'. . rit a,...,.g tr.d.a .#`rgu.;:P g.- <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> ....: , _. m.,:, , .. , m ,, . mwE.. �. �r v.. u. w ,o.awe4k >axea:;":2.,mu$u..� ,/.Yx.,�. MMAKRu...= < Y x*M., „W_�: -. .:Y'i,. :3.46.*:;,,. ..d,50.. ..at. x, .....R7bw4W.Z.4- s`:M:. <br /> I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> F - 7 Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw Ti LP /Natural Gas - ANNUAL Sale <br /> DR" Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 1Qtrly1 )Semi' 1 I Other <br /> Sprinkler I ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> FT Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> I Other: I <br /> imoorazommvotagnmex ,,' • -sz.,irgammaz•::',.(0-aommAimmaimivatraammomtimagiu,gcl-N,Azzazi,Limaka,=:.i.azgual,:amta:ABgazzakagalmtlanmaimmaz,23,, <br /> Contractor I Company 64- <br /> :.1"/ 4 �(P�. ' s ' <br /> Signature Registered N j Fee Current 1 / N <br /> Addrele Off, 84-k, L 4 s 5;1ci4 --„L toc 3 ,35 5 I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I ( License # <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current Y / N <br /> Address <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y / N ] Fee Current I Y / N - I <br /> Address 1 <br /> I License # I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address I 1 License # <br /> 1 :d�.:..._:"S: - t,:...�'° <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 />