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813- 780 -0020 City of Zephyrhills•Fire, Fax- 813 -780 -0021 <br /> Permit Application . <br /> )ate Received MAU /4 Phone Contact for Permit <br /> )wner's Name .. ._ Mg" .` II - � s 9.. ---42. Owners Phone Number 1 i ��, 7 77 0 7 <br /> owner's Address I 7a 3 U 3 , N, C AJ"c... , 7 k c k ii S -F i 3 3 5 9 4- . <br /> =ee Simple Titleholder Name u Titleholder Phone Number ( , I <br /> =ea Simple Titleholder Address I <br /> Job Address S 3a 5 , . - - ►- . 1 ; f( 33S .1-- Lot# I <br /> Sub Division r . , # E ... Parcel # I Dom[ ' 4 - )1 - 0 14 4) •CUUrA OQ -OD v <br /> . . Od <br /> n Bio - and Waste Storage - ANNUAL Ei Fumigation Tent <br /> rI Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ri Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw = LP /Natural Gas - Installation <br /> 0 <br /> Emergency Generator> 30 kw Gas - ANNUAL Sale )� r <br /> Fire Protection Maintenance - ANNUAL Places of Assembly - ANNUAL 1 <br /> " mu GBI timer / �j <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum 1 LL---...-- <br /> t- <br /> Are Alarm 2 ❑ E 1 [j Sparkiers 1 <br /> Hood Cleaning E ❑ ❑ ❑ I I = Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Q Fire Alarm Installation r Torch Roofing/Tar Kettle ,r� L/ <br /> Fire Pumps I-I Waste The Storage ANNUAL 4 7 L' � I / <br /> Fire Works • <br /> Flammable Application- ANNUAL 1 <br /> ! Valuation of Project <br /> Fuel Tanks <br /> Q Other. I <br /> Contractor I // ` ai <br /> Company L i G . 1 <br /> Signature 1 /S 1 5 r <br /> Regis Y / N Fee Curren Y / N <br /> Address Ls-1g / 9 / , /2/ �„4._ , License # I E-r ooOp y6 I <br /> ELECTRICIAN! I Company <br /> Signature 11 I ! Registered Y / N Fee current Y / N <br /> Address I <br /> 1 License # I <br /> PLUMBER I <br /> Signature <br /> Company <br /> Registered Y / N Fee Current Y / N <br /> Address i I License # j <br /> MECHANICAL! <br /> I Company <br /> Signature Registered Y / N Fee Curr Y / N <br /> Address I <br /> 1 License # <br /> OTHER <br /> I ! Company <br /> Signature <br /> Registered Y / N Fee Current Y / N <br /> Address <br /> License # <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> • <br /> If over 52500, a Notice of Commencement Is required (Mechanical work over 55000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel 0- obtained from Property Tax Notice htt : //a <br /> P riY ( p ppraiser.pascogov.com) <br />