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813-780-0020 City of.Zephyrhills'Fir•.e. Fax - 813780 -0021 <br /> �{ 9-/0 Permit Application <br /> Date Received d ` Phone Contact for Permit <br /> Owner's Name 4 P�IJi91 Owners Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ,y>uaa w .,, rw, ,. . t"m.t " a, . >F .,; `*oi . 1 H . 7. t 3e V ,^ v ,w — , ,,,.,,,, .• . ',S1.4., e.. WT !d at ' p <br /> Job Address V 37361 C'. t ft Tli tt Loop 2'phyr1► 115 FL 335 `f Lot # <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL nj Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> Emergency Generator < 30 kw I LP /Natural Gas - Installation ''\. <br /> I Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL e I fr <br /> Fire Protection Maintenance - ANNUAL /(�' Places of Assembly -A UAL g <br /> )Utrly1.1Semi1 f'� l Uther _ `z � ((( / <br /> Sprinkler n ❑ ❑ ❑ j Recreational Bum " <br /> Fire Alarm n ❑ ❑ ❑ 1 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ l 1 1 1 Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ ) I I 1 Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application - ANNUAL ! ( Valuation of Project <br /> I Fuel Tanks <br /> rI Other: A <br /> Contractor � � Compan y �j v C Signature Registered Y / N Fee Current Y / N <br /> • <br /> Address <br /> License # I <br /> ELECTRICIA' Company <br /> Signature Registered Y/ N Fee Current I Y / N j <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current I Y / N _ <br /> Address I <br /> I License # 1 <br /> OTHER <br /> Company <br /> Signature Registered Y/ N j Fee Current 1 Y / N j <br /> Address I <br /> License # <br /> iDDire Directions: <br /> ur. As sMw mN = <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 - days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />