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813- 780-0020 City of Zephyrhills Fire i W6' y Fax- 813 - 780 -0021 <br /> Permit Application 1 <br /> Date Received II one Contact ontact for Permit <br /> Owner's Name IAmgRvtAN 14 LTA ■Vsrirurc., TNd Owner's Phone Number 1813 I :0 1 iioo 1 <br /> Owner's Address 13 DAu. r 4r I! ky (kb. 2 EA►-(YF/141‘LY ri.. 23 Sci / <br /> Fee Simple Titleholder Name Titleholder Phone Number I f <br /> Fee Simple Titleholder Address <br /> Job Address ( 37 9/41 . Au.t 'rER RO. 2£ pi-( yP 1=1 15'y 1 Lot # <br /> Sub Division ra _ _ Parcel # 0 _6— t- O O O - O0 00-0030 <br /> „ : „,E.,,.. ., € ..., -r 2.? ?,a _ r`TW"tFu'. +01 m•E •• = .4.', ? : •:x 4 4 • 4ra ` , - ' •KRs " S §s .... 440"4s . 4 ,x.,W •'i • <br /> n Bio- Hazard Waste Storage - ANNUAL I= Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> Controlled Burn n LP /Natural Gas - Installation <br /> E Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I - 7 Emergency Generator > 30 kw EJ Places of Assembly- ANNUAL <br /> n Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> try (SemiI WU Other <br /> Sprinkler ® ❑ ❑ Ix n Sparklers <br /> Fire Alarm 0 ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Cleaning n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Hood Suppression El ❑ ❑ ❑ I 1 n Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> El Fire Pumps <br /> Fire Works <br /> n Flammable Application- ANNUAL l I Valuation of Project <br /> n Fuel Tanks <br /> 0 Other: 1 I <br /> a e 3;E, h< sF>. K:4:1 ;a • a -4. mom' AMi i O« K;a rrt; 2;n .'..MEe;".4 V .. <br /> Contractor a ^ Company A SF} ►- ItTy MAT 1 C S 1r.? f4fllf o Qi90 - 1 <br /> Signature l J CO C 9f3u..>r (L Registered Y / N l J Fee Current Y / N <br /> Address 1.2191 11 rG'CttiAG¢ Sr. ,LA a Co 1°1. 3 3)) / 1 License # I I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address 1 I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address) License # <br /> ,. .. x's^v •• � ... ,,,,:,:7 . «... *€ eesEx ... ; ..;.., ,x %..,...,F, E i a ; mia.z�. _, . ..... ..> ,,..,.� .eaWat z lgT.. :: :, : ._ ._. , a . ... ,.w ... _._ .. .__ ..,, <br /> _.� is <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 />