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8137$0 -x1 - City of.ZephyrhillsFir• Fax-813-780-0021 <br /> Permit Application _ <br /> Date Received Phone Contact for Permit <br /> Owner's Name C ' a(4/A7 0g %t 7 elv.e/ Owner's Phone Number 1-1.7 J Iszejr <br /> Owner's Address 3PJS' �S 1 .414 l I ' <br /> Fee Simple Name Titleholder Phone Number <br /> Fee Simple Address I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage — ANNUAL n Fumigation Tent <br /> 1 1 Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> FT Emergency Generator < 30 kw n LP/Natural Gas - Installation <br /> I 1 Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL • I I Places of Assembly - ANNUAL <br /> lC.tnyl Semi! UM Uther <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 1 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I l I Sprinkler System Installations <br /> Hood Suppression IN ❑ ❑ ( I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I I Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I 1 Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> 0 Other: 1 <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address I I License # ( 1 <br /> ELECTRICIAN Company <br /> Signature Registered _ Y/ N I Fee Current 1 Y / N <br /> Address ) I , License # ( <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address 1 I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address 1 I License # j <br /> OTHER Ilr Company , L N // �44 �1/ /�� e./ 2 C.d.. <br /> Signature _ Registered Fee Current I �N <br /> Address — � <br /> License # .t ' <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: /lappraiser.pascogov.com) <br />