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(di <br /> L. , -780 -11620 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received d j Q Phone Contact for Permit <br /> ` (") <br /> Owner's Name l ' \ <br /> rj l it S De l +,A/1�i►�.� 5 -i - re Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple - Titleholder Address I <br /> ;. ... s .., .k: ',. , on metia 7 ;% `s*Fs :�,�f3 : ` �c ` ice "; ="« z ' ca mmarm *.: ` � leg "` . s`:.. . ,.., �.,r.. L hn n a;Q: ,., <br /> Job Address 6030 Ga I l > >Iv4 Lot <br /> Sub Division Parcel # <br /> y; sT..;§_:IM , t gAtii* aft¢M.a4 «MUM:IZMOWATOSZ4 Y`G7MO MU t . ' 4:,.:m., _ , ...,,SM :». ;.1r=1 tcks.. P,,.at: = .t,..�i 4 " .»..A r, ,K:-r ....4w_. .,g .:k ;.s»...'.i: <br /> Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Controlled Bum I Hood Installation <br /> 1 1 Emergency Generator < 30 kw ( LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> r---1 Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> LAMA !Semi OA Other <br /> Sprinkler I ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm 7 ❑ ❑ CPI ( ( I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I ( I I Sprinkler System installations <br /> Hood Suppression ❑ ❑ ❑ ( ( ( Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation Torch Roofing/Tar Kettle <br /> r--1 Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> n Flammable Application- ANNUAL I Valuation of Project <br /> 1 Fuel Tanks <br /> ( Other: 1 <br /> :°?1127a.'_i": +a .. 5'. �ec' etw i .v,..,€r °,:: sa mr� z .. ". .x s�;.«.: - : '7*.{' xi'�:' a�tt.:sa: ,w ;:. .,- ,,, .e , ."`...a... .'Eab6 d..: a, =l• l'f,i `Swimft ,y. a z3 •xak :m .,, L2: ;. • <br /> Contractor i Company CA VColg ` -P ; - 5. I <br /> Signature �� Registered Y / N J Fee Current / N <br /> Address ( ( License # 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current I YIN I <br /> Address 1 License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current Y/ N <br /> Address 1 ( License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address License # I <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 />