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813- 780 -0020 City of Zephyrhills Fire Fax - 813-780 -0021 <br /> Permit Application <br /> Date Received i :e _• .. I -7. 1 v 1 Phone Contact for Permit <br /> Owner's Name 6„0)-e--5 5. G�-�f 1Z ,z,„..,fit? 1 Owner's Phone Number 1 11 1 10Z 75 I <br /> Owner's Address t .e." a & _6( 2e k 144,1 ‘5 33 S <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> •,,g`, ,'?•„ms`s s`Qa a <br /> ' R . , .., �NIM , NMI I , ;;,,: 4MICA Ia=n MW r „ ' ,ENI ,T <br /> Job Address 4 6-- r -'c.....-h ¶3 <br /> T Lot # 1 <br /> Sub Division Parcel # I <br /> - aMANh. OUZMZM. r'," ''a*r"krtsuas.Ow.th.,'s.a.., ?"r. #'KR'.M.;. .t . 0 41 <br /> Ii Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> 7 Comm Exhaust Kitchen Hood /Duct r---1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> J ] Controlled Bum n Hood Installation <br /> [I Emergency Generator < 30 kw I LP /Natural Gas - Installation / /� <br /> n Emergency Generator > 30 kw I� LP /Natural Gas - ANNUAL Sale t✓ ( - <br /> �I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL � / n <br /> 1Lttrly1 Semi) F I Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning I ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression V ❑ pie ❑ I I 7 Standpipes (Sprinkler Sys) <br /> I -- I Fire Alarm Installation I----I Torch Roofing/Tar Kettle <br /> n Fire Pumps Ii Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> 7 Fuel Tanks <br /> nI Other: I <br /> Va ... . nVaal2 SAA. ill , ,<, V &.tom <br /> Contractor - � �° �1 li. � /6- -- <br /> ��� Company J , r <br /> ""— '�'!�= � '���� " <br /> Signature Registered Y / N ] Fee Current I Y / N j <br /> Address J License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> 1 License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # .w� <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 />