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813-780 -0020 City of ZephyrhillsFirs. ..W. ( OT,S 5 Fax -813- 780-0021 <br /> Permit Application <br /> i <br /> ilErAMMii Date Received <br /> A - Phone C ontact for Permit ?gyp �L , , <br /> Owners Name : elA Ak I_ C... ?TV4 Z4 . Owner's Phone Number I *13 113 37 1 All 1 <br /> nets Address 5 i ( w t ,4 ✓ '�vs ` <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholderAddress I <br /> Job Address 7431 C _ I 1 t( a (OD Z C? 4.gt -(4 ((.s F i 3 36 Lot # <br /> Sub Division I Parcel # <br /> Bio -Hazard Waste Storage ANNUAL n Fumigation Tent <br /> I-I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 1I or RQ Facility) ANNUAL <br /> I -( Controlled Bum n Hood Installation <br /> I -1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> rI Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Ill Fire Protection Maintenance - ANNUAL nl Places of Assembly- ANNUAL <br /> (Utnyl lSem) i'ilal other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm gj ❑ ❑ g j 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I ( n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ ( ( ( ( Standpipes (Sprinkler Sys) <br /> I —I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Jn Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I Flammable Application - ANNUAL <br /> 1 Valuation of Project <br /> n Fuel Tanks <br /> 0 Other: I <br /> Contractor ' /� Company CIO aCurA w <br /> Signature 4,)- L , ��// 4..1 Registered !NOM Fee Current ���,� <br /> Address I 5'i1 / w- 4v4- -fa7.3 11c-'E" qV/f Req I License # I E FO 04 t I a3 I <br /> ELECTRICIAN Company <br /> • <br /> Signature <br /> • <br /> Registered Y/ N 1 Fee Current J Y/ N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current J Y/ N <br /> Address I I License # J • I <br /> • <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I • License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I ( License # I J <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 (httpi /appraiser.pascogov.com) <br />