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8•3 -780 -0020 City of.Zephyrhills Fire- - Fax- 813- 78o -oo21 <br /> / t /- Permit Application <br /> Date Received r2 `� *, ./ <br /> Phone Contact for Permit <br /> Owner's Name -----7 i h k ra11� LM7iNf Owner's Phone Number . N.3 7 SA <br /> i <br /> Owner's Address ` 6 S k A Ve <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee SimpleTitleholderAddress I <br /> m'?»'`°'u.x.F.iuYf e• '?:*Si�i+"A".= �bY. "-S aBa.?ws'::d � i;4e..'ura«7.re.!`:...,, r ..,.�,.;. -, r,.. -. ., a:titi:z.,j. «„ x, 'R. ,..,:mss x .. .:fir z: 'g,:s'.:,k..;.s"'1"�'� ' ": ,�..*- .,,'°? .x i�c, <br /> Job Address T 6 5 c \ 1 kvr Lot # <br /> Sub Division Parcel # <br /> ws .:.�'` ...::'�' a.�,<,., r -.5, ._ s . fix. -3., u...<..;._ P :-::^• r2 .._5..�2:. t- . �, ._: # a.� a .�:;*rsr .�s�s...- : «,. ,, , <v,.,,.,^.e:i <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 /> n Controlled Bum n Hood Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly -ANNU /D / <br /> Ic.ttrlyl lsemiI tither )/ (Q <br /> (A <br /> E ning n I I ,P ❑ ❑ _,J2' I n Sprinkler System Insta tions C l� <br /> Hood Suppression IT ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> L I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> IR Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> n Flammable Application- ANNUAL I ( Valuation of Project <br /> n Fuel Tanks <br /> n Other I <br /> l <br /> Contractor /^ / / <br /> Company fr rGIr. c\ r .. UG l�iill y( 1 6ksekr o Signature �//' C Re istered Y/ N Fee rrent I Y/ N <br /> Address I S A C� hQ� \\ i cy - „, � �) .71, f ,\AL License# I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N J Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N ] Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current I Y / N <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N ] Fee Current 1 Y/ N I <br /> Address J 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 />