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813- 78(=0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received I 1 Phone Contact ho a Co for Permit j t I 3 1 6 llp2 11 < v7-4!)0
<br /> Owner's Name 1 A Cpn'f . Assn O'!• 7th Day Adden1, s I5 Owner's Phone Number 1
<br /> Owner's Address Po SOX cRIP A, (.0 i rifer Pa rk /'- 1-.- 3 L7 !o
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
<br /> `x '. .f w ga 'i f '?:.R « i, kt: 7agi+ .,.. fi.,Y`°`G S.r , v. ti. .�P ? t-' • .. .x`"kRi t a'st iA roll i.r3 , .`_ u` i' , .inSix - ,. `. x W' ; �`sr «.:a K,...At3.;...Yo, a,,,x .3. r : , d 7‹:,, Job Address / 333 0CtI 12C ' Lot#
<br /> Sub Division Parcel # �� -015' r R/ 0010 d �� 00
<br /> ,. riaxv?m,".Y.... a;r E` . .'. ai+. rs:,, t.,,. .. , c ; ;-wa v ,....... a " 'tom. h, :,,z ::.^, ''" 'i mv,, . - '�`c:=, -t k.. aA ,txgtpN .4 2 .a �, �u,,,w .'. `,»,�Crs'',
<br /> E Bio -Hazard Waste Storage - ANNUAL fl Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> r Controlled Burn n Hood Installation
<br /> r 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> SC I Fire Protection Maintenance - ANNUAL ( I Places of Assembly- ANNUAL
<br /> r y 1 semi ( FAFTj other
<br /> Sprinkler II ❑ ❑ pg. r- Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning E ❑ ❑ ❑ 1 I n Sprinkler System Installations
<br /> Hood Suppression EI ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> M Fire Pumps n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL 1 I Valuation of Project
<br /> Fuel Tanks
<br /> F-1 Other: 4 ,,
<br /> Contractor FA�, ; Company j r i
<br /> •
<br /> Signature Al Registered riam Fee Current NMI
<br /> Address rMI� /WrJ%/,� /MBIMIIM License # I O,<6'j /7y■0OC // if I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I 1 License # I I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I 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 I I License # I I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N 1
<br /> Address License #
<br /> 10 m €':sic vt.',-a: • .... ... , ::: mwe......4,, , - .,. - . ^ - - �..A �. w s.; . ,.« a._.«:, r: .:G:,,,,,,s.;.a a �=.,4=
<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)
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