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813-780 -0020 City of Zephyrhills "Fire. Fax - 513- 78o -oo21 <br /> Permit Application <br /> 1 <br /> Date Received Phone Contact for Permit <br /> Owner's Name Owners Phone Number <br /> Owner's Address ,S R z) G & 1-(- <br /> Fee Simple Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> :,m -•ss;9 _.: ,..< >- �.z. ..e,u...aw: rz _a , .,.« .....x,.. x,., ,. ...._. ... .�. ._... �. x.�:u. r....r.a =«. �,?*< , <br /> AA <br /> Job Address -5 30 �� !O' `' ' Lot # <br /> Sub Division Parcel # <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier!! or RQ Facility) ANNUAL <br /> n Controlled Bum I I Hood Installation • <br /> El Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> r y lbemi1 (J °trier <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning 2JJ ❑ X ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ID ID I 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> FR Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> n Flammable Application- ANNUAL ( ( Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> Contractor / Company 1✓ yt / y .,, ,, y �A� ` <br /> Signature Registered Y/ Fee Currant S I � Y // N J <br /> Address 1/2_5 c G zi S'-/ /-,. 4.4-7 , License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N J Fee Current 1 Y/ N 1 <br /> Address) I License # I I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y / N - I Fee Current I Y / N <br /> Address <br /> License # <br /> Directions: .._ y.. <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 />