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813-780-0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> - Permit Application <br /> Date Received Phone Contact for Permit `��� g S <br /> a o-. -,gin ..�.�. �s , „<,;K,. ,, - _. ,. • , i .a >. - , . MrZR =P: T :O > .AMMO .n . - as r a , Wi t... -.... .,-.. ,,m T� J <br /> Owner's Name It t-/ a.Cif le nl r ? 5 , -_7:b Owner's Phone Number f Zi / � 1 le, 171 1 19 3/5” <br /> Owner's Address P O O /\ -! 1 'Z 0 7 "r 70 q_ r4- 3 56 • <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 J I <br /> Fee Simple Titleholder Address <br /> '9(/ Gil i3/ I'G( 7 f/L y r`t r //Syr --7L. L5 5 Lot* ^ <br /> Job Address S 1 <br /> Sub Division Parcel # / d c26 -021- /JO X DoO �r irC <br /> Bio -Hazard Waste Storage - ANNUAL I ( Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum n Hood Installation <br /> Ti Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> F ire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUt"yJ !Semi' 1721,ther <br /> Sprinkler ill ❑ ❑ 1 1 Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 1 1 Sprinkler System Installations <br /> Flood Suppression I ^ I ❑ ❑ ❑ I I I 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> Fuel Tanks <br /> • Other: <br /> Contractor � � ` „ (// f ,tom, <br /> � Company �'FC'AjS ✓C <br /> Signature Registered Y / N Fee Current �Y / N <br /> Add - ; 5 0 __ 5 (.d. A.) tti'E4 "ie . Tp4 7=L ( License* 1 11 % .9_7 3 00O! =0071 <br /> ELECTRIC • N <br /> Company I <br /> Signature Registered Y / N 1 Fee Current Y / N <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N j <br /> Address I I License # <br /> OTHER • Company L <br /> S <br /> PFI <br /> ignaturz- lA la p y � l� • __. <br /> rr- Registered Y / N Fee Current Y / N <br /> Adress • cp g /- License # g %� I � r <br /> Direction • <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 />