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813-780 -0020 City of.Zephyrhills Fax- 813-780 -0021 <br /> . . Permit Application _ . <br /> Date Received <br /> Phone Contact for Permit <br /> y - J. . / � �,« _ .r. , .,.fix_ >.�•.... <br /> Owners Name fg r e i ! Ly / 7 Z Owner's Phone Number ( I � K <br /> Owners Address g, 3v 647-r f/tir <br /> Fee SimpleTitleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> : ,.a�.r�� <br /> Job Address _5-g, GH'w 6 Lc , Lot # <br /> Sub Division Parcel # <br /> . . <br /> n Bio- Hazard Waste Storage -- ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> EI 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 /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> l Utnyl l emi l Uji tither <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning. ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression F2I ❑ ❑ 1 I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I I Fire Pumps n Waste Tire Storage ANNUAL <br /> ri Fire Works <br /> n Flammable Application- ANNUAL I ( Valuation of Project <br /> n Fuel Tanks <br /> n Other: I I <br /> A�K.vI tS k£iY #un*3 ✓48'.44:'_'2Y 44 1 .ti?.`$.:.. _? i<r.., _ —q- -y �a m,. ,,, .c }mu.;.4e'n.... 'rns d.<✓e + - { *.k, na,.,...,,_ 4....Yn_ .,$4"�—,^t^»`4*«444 =s�14 W',::...5 r 4,d s._.. 4 R+F.+znn ar. <br /> Contractor Fp + Company riMf/1 /j -c-j fZ 4C E LQ , Signature ` ►_ _IY / /�L�� Registered !! Y / N 1 Fee Current I Y / N 1 <br /> Address I /7Z 52. 3 _ 6 Z Cf i/, y gii /4 License # I . <br /> ELECTRICIAN gnature <br /> • <br /> Signature Registered Y/ N J Fee Current I Y / N I <br /> Address License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I ( License # I I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address License # <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 />