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813-780-0020 City of.Zephyrhills Fax- 813 -780 -0021 <br /> Permit Application _ _ <br /> Date Received I Phone Contact for Permit <br /> Owner's Name 11i fv(_ t , r Z )14me' c-ko Lc Owners Phone Number 6 j.s- 6 q Uq p <br /> Owner's Address /, ? j' l.?Z 4 `EYr k, t..A-1 -- c- 4 L i 0 It - 7 ^ 1-1-1 1... LS .3 2 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address i/ ' c.„, 1 e_opk.CiA"r"0 )- ■ 0 '- Lot # <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Faciitty) ANNUAL <br /> n Controlled Bum n Hood Installation ! ' ....,.//) <br /> n Emergency Generator < 30 kw n LP /Natural Gas- Installatio n /10 <br /> n Emergency Generator> 30 kw n LP /Natural Gas -ANNUA Sale / / 0 <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly -A NUAL <br /> Iutnyl'Semi) Wilil Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ • ❑ ❑ I 1 1 1 Sparklers j/„ 6 <br /> Hood Cleaning n ❑ • ❑ ❑ I n Sprinkler System Installations iJ / W <br /> Hood Suppression E ❑ ❑ ❑ 1 I n Standpipes (Sprinkler Sys) ( <br /> n Fire Alarm Installation n Torch RoofingfTar Kettle <br /> n Fire Pumps - n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> IN Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> - Fuel Tanks <br /> Q Other: I I <br /> ' <br /> Contractor 41111r/7 Company ,1- L4 d I V 4&� O <br /> Signature v" / � / Registered Y / N Fee Current Y / N <br /> Address I 21 CeQt t_i -1 b.{ , 7- 14-1/...L. 1 License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N J Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address 1 I License # <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current 1 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 (httpJlappraiser.pascogov.com) <br />