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. 813-780 -0020 City of Zephyrhills '.. u C(y Fax-813-780-0021 <br /> Permit Application f I J f _ <br /> Date Received i Phone Contact for Permit <br /> Owner's Name W • a '� =C <br /> ' \5 Cos-.. Owners Phone Number <br /> _ <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Address 1 <br /> Job Address 11.\ Co 5f<De.Lk Cottal <br /> Gaal ' k 33Sk 1 Lot# <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> l I Controlled Burn n Hood Installation <br /> I -1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL • n Places of Assembly - ANNUAL <br /> )UtriyI )Semi) Will other <br /> Sprinkler T7t ❑ ❑ )5‹ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I ( I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarrn Installation I-1 Torch Roofing/Tar Kettle <br /> I I Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I I Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> FT Fuel Tanks <br /> jn Other: I �. <br /> Contractor 1 /' — ►`i _ Company G CLX(\OV.L COCt <br /> Signature Re 1 `( N I Fee Current f Y �N I <br /> Address 1 ( License # I <br /> ELECTRICIAN Company <br /> Signature Registered _ Y/ N I Fee Current 1 Y/ N I <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address 1 I • License # I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address License # <br /> Mita <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 32500, 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 />