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. 613 -780 -0020 City ofZephyrhills'Fir:e Fax- 813-7ao -oo2l <br /> Permit Application <br /> Date Received Phone Contact for Permit L 1 <br /> p <br /> Owner's Name Ls , r �S —(cu lrQ0.fZk\ t 1 C . Owner's ner's Phone Number V 1'3 8'g 6 <br /> Owner's Address 503 y c 8+ S - 7 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple 'Titleholder Address <br /> Job Address 503. kl t S-}-re �- Lot# <br /> Sub Division • Parcel* <br /> 1 Bio-Hazard Waste Storage - .ANNUAL n Fumigation Tent • <br /> _ Comm Exhaust Kitchen.Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> • n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30•kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> [eii.[7 ]bemri n ' utner <br /> Sprinkler n ❑ ❑ 0 - n Recreational Bum <br /> Fire Alarm ❑ ❑ Si— 1 1 n Sparklers . <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ .1 I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm installation F Torch Roofing/Tar Kettle <br /> 0 Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application ANNUAL .) I Valuation of Project <br /> Fuel Tanks <br /> n Other: <br /> Contractor <br /> Company C ! cr I p ct -W <br /> Signature Registered Y /,N Kt Fee Current 1 Y / N i <br /> Address 1 I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current 1 Y / N I <br /> Address 1 ' r License# <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N <br /> Address I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current 1 Y N <br /> Address 1 I • License # 1 I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N <br /> Address 1 I License # I <br /> tor. <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 (httpa /appraiser.pascogov.com) <br />