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) <br /> 4 o),-7,0 <br /> . 813780 -0020 City of.ZephyrhillsFire. Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> ..._. �¢xad�.sres4'�5- i8�'MY�ca ,,: .xF ,_., ::„•....,..,.. w., ..r�.xu,:n,...,,w.,a:.*�c °°^� �:.5,.r ,� 4. �..-r ; ,,, ..x -.,. ::: - - .�'-� �� �..� <br /> Owner's Name Ps 4) r7dt Assiski L U . Owner's Phone Number ') 3 75 <br /> Owner's Address -7 //aid ' ud ZIO ,, r1 115 1 R., 335 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> �ii&R�n aS `_ -'�,. 4 .it , .� Yri.''a°e,3 N.eJ35, tia"w �;w: =° , *5•d:.z^a FY .: ... <br /> a „wxu, ,rkw, ,. ,_ r. -a... ^ti:::iS, ,. D'�''�s.:.x -m .F -„ ,...... �.,cg � .. F � c:.: "s�'w��F.'.,..Y'�..'.. Ra•�§k�ui"`,Xunk„u'iaA,a�`•m .'X xv.. n'axrr xiSx`: <br /> Job Address Lot <br /> Sub Division Parcel # <br /> I I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct 1 I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I ( LP /Natural Gas - ANNUAL Sale <br /> 1 Fire Protection Maintenance - ANNUAL • \ Places of Assembly- ANNUAL <br /> IUtrly1 . 1SemtI Pfl Uther <br /> Sprinkler n ❑ ❑ ❑ 1 I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ f 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I l I Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> HI Flammable Application- ANNUAL ) I Valuation of Project <br /> Fuel Tanks <br /> n Other: <br /> Contractor / Company <br /> Signature s '44111- `rte Registered Y / N I Fee Current I Y / N <br /> Address 4. J License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N _ Fee Current Y / N <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N _ <br /> Address • I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current I Y / N 1 <br /> Address I License # I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address License # <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> ff 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 />