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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 <br /> Owner's Name I /¢/y'/`/ 8 /9 A7%,-1• / Cl u,FCi /A e I Owner's Phone Number f t i.3 I 17‘ 2- Ile cPcrO <br /> Owner's Address 13 el 3 V W, 54z L: 4S7 , 2 EP 1/56e60( IL-LS t /'L 33S1-2-- <br /> Fee Simple Titleholder Name I Titleholder Phone Number I I I <br /> Fee Simple Titleholder Address I <br /> 1 � 4 ( /� cT <br /> Job Address 86 �W l �19� / 2 C^ P 11 y � t / / � L � Y'`L., 3J9/ 2-1 Lot # <br /> Sub Division I Parcel # 1 <br /> Eta - x.a tawm <br /> Ei Bio -Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> E Comm Exhaust Kitchen Hood /Duct El Hood Installation <br /> E Controlled Bum Q LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw = LP /Natural Gas - ANNUAL Sale <br /> E Emergency Generator> 30 kw ® Places of Assembly- ANNUAL,.-' <br /> Fire Protection Maintenance - ANNUAL Recreational Bum / 1,7 r y ml GTtll L'ii tLL M �� I. <br /> Sprinkler E ❑ ❑ ❑ 0 Sparklers ti <br /> Fire Alarm 0 ❑ ❑ ❑ I 1 = Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ ❑ I 1 0 Standpipes (Sprinkler Sys) <br /> Hood Suppression ❑ ❑ ❑ ❑ l 1 ED Torch Roofing/Tar Kettle <br /> E Fire Alarrn Installation = Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> Fuel Tanks <br /> 0 Other: I I <br /> � .2' `+i3 b. 3'.s" k8, ..:'.� iw, 5�P2`, of..:3.A .Gti Sd.�': `. Yfaf`sN .;.4465 .,.« - #' N, ..q=.h a.9k /k..' .,.4 ... ._„ 44 :GY. ,... .Gas`f.'a'. ?llte}", ;4t'i e i.H,L4P - %a.., h °£n_e. +?. `.+Tffi +. 45&.s`:a'.aa wrviMk S4„ x o..Acz_k. <br /> Contractor 1/ / /1 Company I <br /> Signature � / —. ,- - '' ` -4----- Registered Y / N I Fee Current 1 Y / N <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I 1 License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y / N <br /> Address License # <br /> fi ^. a i, u, <'""4.. . > -vt<, �,.as,.:.,..ro .:w _ m,...>.' n< .. „ a ....w„ sm e ...,.� a _ ..- . ,ru4n° 44— ..zS „ 4."Y•d ,R' �, w -« w.., <. .,» .. '_.N t1,4443 s <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 (http: / /appraiser.pascogov.com) <br />