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813-780-0020 City of.Zephyrhills Fire- Fax -813- 780 -0021 <br /> FOR- 0 # � P- it A.piiication <br /> O f0 / (/ Phone Contact for Permit e i <br /> Date Received/- 7 <br /> I ��' s ^- e`er'- 'aw-- .o�- ,:adr� <br /> � :.,�. �.�.....,..:y,� .1 g /' c ?C- <br /> Owner's Name / 72L�/ - ` Owner's Phone Number 6 1 3 I `T - — 1 3S 1 <br /> Owner's Address 'P WA / J g T4HP TL 3 36 ' <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> t. <br /> ":;f v�k' aa' 3'. r.. 5dc;".>. iF+ M*,. ae.;; a-: x,. s3.J s. y,.v6?.tA�,•L.. & "_;."ss'<'Y -,s. ,._x +:'r .>x.., -mr .r,,, _7= `.xY -hw,. 'ar::ax.".�' ,a. -.+:. ..x �'a^.s t +arm dr .+, <br /> UN 6 6 5I1i 6ffLL hLV ,D. 1 Lot <br /> Job Address I - <br /> Sub Division 1 I <br /> Parcel <br /> n I I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> • <br /> I I Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw I ( LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> I Utrly1 isemi ( rATT1 Other <br /> Sprinkler ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I . 1 I 1 Sparklers <br /> Hood Cleaning VI ❑ ❑ ❑ I4 Ma: I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 1 I I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> I Fuel Tanks <br /> I Other: I,, .r., <br /> Contractor Company tiEW 7' 1Q /ocS <br /> Signature G44 G� Registered Y / N C' s Fee Current I Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address 1 1 License # I <br /> OTHER Company <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address License # I <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 />