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813- 780-00 / 4(.7,0._ City of Zephyrhills Firms Fax-813-780-0021 <br /> I <br /> / , ,- ''r 1 -G� Permit Application - _ <br /> /ate Received <br /> Phone Contact for Permit <br /> ,,, .. ..: � ., • n.. �,e .�,. ._ - - . � �..�,w, �.�, � .. <br /> � � <br /> )wner's Name 7 G a, y III, a : - MIIIPM � � Owner's Phone Number l v3 <br /> owner's Address 5O c) LIP 5-4 s4- 2 e hr 41 V C I 3 3 54 a. <br /> zee Simple Titleholder Name I I Titleholder Phone Number I I , <br /> =ee Simple Titleholder Address <br /> Lot # <br /> Job Address <br /> Sub Division I Parcel # <br /> n Bio -Hazard Waste Storage - ANNUAL ED Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL ,�i <br /> n Controlled Bum <br /> n , <br /> Hood Installation Lr P � , '�. <br /> ' � 0 -� 10 <br /> n Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw LP/Natural Gas - ANNUAL Sale <br /> ji <br /> Fire Protection Maintenance - ANNUAL \ <br /> I 1 Places of Assembly- ANNUAL <br /> Clai ,semi �i f"� li l •- <br /> Sprinkler Recreational Bum <br /> Fire Alarm El ID 1 ❑ A( I I n Sparklers ) <br /> Hood Cleaning <br /> I 1 1 1 Sprinkler System Installatio s vJ <br /> � El a r:3 <br /> Hood Suppression Ej ❑ ❑ ❑ I y n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle .. <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL II Valuation of Project <br /> Fuel Tanks <br /> n Other: <br /> Contractor Company I 7•ai:l APP _ , L'ii�T� G <br /> Signature 7 Z Registered r $ Fee mint <br /> Address I • 3' igiFTMIMIC?S NsE€j -_ 5 License # IE F 1 (9O O 13 L Lo I <br /> ELECTRICIAN Company I <br /> Signature Registered — 77 - 11 Fee Current 1 Y/ N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I 1 License # I I <br /> MECHANICAL Company I <br /> Signature Registered , Y/ N I Fee Current I Y / N I <br /> Address I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <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 />