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813 - 780-0020 City ofZephyrhills 'Fire -,. _', • Fax -813 -780 -0021 <br /> Y � � j Permit Application <br /> Date Received / Phone Contact for Permit I I r <br /> .:?.err : . , ...,, _- x..... -_..- .. < , <br /> Owner's Name 1/ PIA f G 64/ DeA1 _ Owner's Phone Number . f ' '7k/Q' I //t k', <br /> Owner's Address ✓ / / j / V - / <br /> Fee Simple Titleholder Name l � Titleholder Phone Number 03 7J'/ 4f 4 .-- ' <br /> Fee Simple Titleholder Address <br /> Job Address <-/ ( S / GL l S / ) // { /T/ L j 71 4 33. --ci Z - Lot* <br /> Sub Division Parcel # <br /> El Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I - 1 Controlled Bum I Hood Installation <br /> FT Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw - LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL r� Places of Assembly- ANNUAL <br /> ' Utnyl 'being rai Uther <br /> Sprinkler n ❑ ❑ ❑ IN Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 1 'Sparklers <br /> Hood Cleaning ❑ ❑ ❑ n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ ., I , Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ( ( Valuation of Project <br /> I Fuel Tanks <br /> n Other: I <br /> Contractor �' Vhk-Me— Company , ..,"./4 /..;.,,e es3v . <br /> Signature Regis tered Y N Fee Current Y / N <br /> Address I� I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N . 1 Fee Current Y / N I <br /> Address 1 I , I I <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y / N 1 Fee Current Y / N .1 <br /> Address I 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current Y / N <br /> Address I I License* <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N <br /> Address License # <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 />