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813-780-0020 City of.Zephyrhills -Fire X 1 5 Fax -813 -780 -0021 <br /> A. Permit Application <br /> Date Received L f ' <br /> — 0 r/ Phone Contact o for Perm <br /> Owner's Name LA' Z e, io 1, y r PI (AL e1 LL(, Owner's Phone Number '729 I So "! I I () 0 <br /> Owners Address ZZ- Z� '� �� �T r �C-\ �� S-1.- l' i-er -, L x `i 1'6- S 7 ( 1 <br /> Fee SimpleTitleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address - 6 S f G r t\ \ \o o t €i kiL,..r.3 4'7 /03 ----- <br /> Lot# 1 <br /> Sub Division OZ Z6 _ — U <br /> Paroel # <br /> oa l 0 5'oa <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent — v 6 I 0 <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation r� -~ <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation ` `� � - J� 1911:Y— <br /> n Emergency Generator> 30 kw Ti LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Iutnyl ISemil raj Utner <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ O ❑ I I S• - - -, <br /> Hood Cleaning n ❑ ❑ ❑ I I Sprinkler System . _ ; . <br /> Hood Suppression ED ❑ ❑ ❑ I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps In Waste Tire Storage ANNUAL <br /> FT Fire Works <br /> Flammable Application- ANNUAL �� 1 ( Valuation of Project <br /> In Fuel Tanks <br /> EZr Other: • • \ • r • Ot! r S <br /> y � . <br /> Contractor <br /> Signature et Company 'WSW- <br /> /L �rl �E = l <br /> Registered ��1 Fee Current Y / N 1 <br /> Address I <br /> License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address I <br /> License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N j Fee Current I Y/ N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N j <br /> Address <br /> 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 />