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813 - 780 -0020 1 l City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> A ✓/ t: � Permit Application <br /> Date Received t' Phone Contact for Permit F J I <br /> Owner's Name I Y . f 1 (ti p ig P OlGr § P Number (al I ( 11 I I,(eal <br /> Owner's Address (6Gi:35" .t r C51 „ O ( - 2 j► ych t l iS i f2— 33 52 1c• <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I I I 11 I <br /> Fee Simple Titleholder Address I <br /> : mTr <br /> .,., '� s - aa�. ,..:.,,. �.i. - - . : . a. �:+® 1�Ya. rroais r ). . ,.... . . 35 Job Address • Z e , ( h t i t s ft, s--()__.. I <br /> `-( Lot # I <br /> Sub Division I "C Parcel # <br /> ,:' ,. , ,.,5 ,...,',..,;,7,'` : S'»* -. ;+.=wr «^SS,„r*< .' 3 :;�"' ..,.. 71 ' a;„a -4`,,, v^.ws,ikp. <br /> E Bio- Hazard Waste Storage - ANNUAL rI Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> EJ Comm Exhaust Kitchen Hood /Duct 0 Hood Installation <br /> E Controlled Burn 0 LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw 0 LP /Natural Gas - ANNUAL Sale <br /> 0 Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> II „ Fire Protection Maintenance - ANNUAL 1E Recreational Burn <br /> El r y UM 'Other <br /> Sprinkler ❑ ❑ ❑ <br /> Sparklers <br /> • <br /> ( Fire Alarm_ <br /> ,,, ❑ ❑ I I Sprinkler System Installati. s <br /> Hood Cleaning Ej ❑ ❑ ❑ I I � �� <br /> Standpipes (Sprinkler S ) -if /�7 <br /> Hood Suppression El ❑ ❑ ❑ I I ❑ <br /> Torch Roofing/Tar Kettl- <br /> Fire Alarm Installation n Waste Tire Storage ANN • • <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL 1 Fuel Tanks I Valuation of Project <br /> Q Other: I <br /> Contractor I Company <br /> Signature I Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I License # I <br /> ELECTRICIAN! I Company <br /> Signature Registered Y / N J Fee Current I Y/ N <br /> Address I I License # <br /> PLUMBER I I Company I <br /> Signature Registered Y/ N 1 Fee Current I Y / N 1 <br /> Address I I License # I <br /> MECHANICAL! <br /> I Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER I <br /> 11 I Company (z fn I <br /> * Signature I �" �-� � i` �') ��Q.C.IIL�t Sf <br /> Registered Y / N ( Fee Current I Y / N I <br /> Address S -- j �l e <br /> q•.3 License # <br /> Directions: <br /> n <br /> s <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 htt //a <br /> . - �/ ( p: ppraiser.pascogov.com) <br /> p L ia: L j Y't_ (a 1-(),u ilk-A- Cfr..k i 0 om <br /> 0 11 Ili <br />