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813- 70zi0-002o City of Zephyrhills Fire <br /> Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I /-Z / /0 <br /> Phone Contact for Permit <br /> Owner's Name / , 4S(6 /l C 6J?)A'A( . Jr•9( Ct p fZ ,( 1 Owner's Phone Number 1 I I u r. I <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 1 I I <br /> Fee Simple Titleholder Address I <br /> „ : «. ^, # , .:; fie, . lac x &ONG ,.< , 3 <br /> Job Address Z/- M5 ??CT77 Sp972zov e, • g /3- ii?,. 6) 2 Z S-- Lot I <br /> Sub Division C 47^ ?CA rc <br /> c1 / /Mt.I.rc ( NYAZR64 C'N t�" Z I <br /> Parcel # <br /> ^,ter: ? ,..._, ..: , }A e._. »,.. w4i:4R: a .swaabum ^.,:e�.,"a�.".- ` <br /> :.Liam.„ ' sma z"a`a^' ,�a�x: =36: w. ..: 3 z ka & ..+; ,s;,w.. .: :i3 tt ,n,:,.� #�9 -=,x ik44.ca,t ws,N...._ , x, .. ^..;: 4 4is. TM,w <br /> n Bio -Hazard Waste Storage - ANNUAL r-7 Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> (Utrly1 (Semi n Uther <br /> Sprinkler la ❑ ❑ I�1 <br /> I I Recreational Bum <br /> Fire Alarm J ] ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning D ❑ ❑ ❑ I I I-1 Sprinkler System Installations <br /> Hood Suppression I ❑ ❑ ❑ I I I] Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps JJ Waste Tire Storage ANNUAL <br /> rI Fire Works <br /> n Flammable Application- ANNUAL <br /> Valuation of Project <br /> Fuel Tanks <br /> n Other: <br /> 1 ,,a,:%: �'t €*`'afti ...ro: '.b. €..a' sa 3 ...F.r. W^iVsViiig'E:"°.>�,'.: <br /> Contractor Company <br /> Signature -. _ Registered Y / N j Fee Current I Y / N I <br /> Address 1 I License # I <br /> ELECTRICIANf I Company <br /> Signature I 1 1 <br /> Registered Y/ N J Fee Current I Y/ N <br /> Address I I License # <br /> PLUMBER I I Company <br /> Signature 1 Registered Y/ N J Fee Current I Y / N j <br /> Address I I I <br /> License # <br /> MECHANICAL' ' Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address I I License # <br /> OTHER <br /> I I Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address <br /> Directions: .. w <br /> License # <br /> Fit 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 htt //a <br /> P rtY ( p: ppraiser.pascogov.com) <br />