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a1'3- 780 -0020 City of.Zephyrhills - Fire• Fax- 813-780 -0021 <br /> /0 Permit Application <br /> Date ReReceived - /r'-- /0 Phone Contact for Permit • / 3 7'2 j 3 3 1 9 <br /> , r :. �>" �. fi.' �aYa:, x„ d:` ",�i:52hu- s++ &5�.......,.«xt:sb <br /> Owner's Name b A Ur4-,4 IJ•' - R r riAI /4r J 3 *.ra Owner's Phone Number g 3 ?RS 4 7 <br /> Owner's Address 44 to v.-Ad 1 t yr, )r. Zr,ek..erA Ns F1- 33. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpteTitleholder Address I <br /> Job Address 5frftvt e Lot # <br /> Sub Division Parcel # U A ,24 <br /> ,i ._.. -� � 3 Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I I Hood Installation <br /> Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> ILItriy1 lbemiI Other <br /> Sprinkler I ❑ ❑ n Recreational Bum .1 1 I <br /> Fire Alarm ❑ ❑ •K 1 Sparklers J` 1 V <br /> Hood Cleaning 71 ❑ ❑ ❑ f I Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ I 1 Standpipes (Sprinkler Sys) <br /> I — I Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> I Other: I d c+ FD-e Abt-rw S c4,-.n - 4 nn tual <br /> � _x >� a ,�x- �..:.zG.._., - ::�Fi:"•'- u�"€llUa`"x,F,_ Mai.FMaz `''"��S'�* iairattWal'4 ti lU._..:.¢3«°" >Mc..m,.ik&t'. a. tsu :_..sE,Wi...a .vwa..,�.-1c1 _ _.,:.a1 . 4&Z..,, ....m.Gal;......M,... <br /> Contractor Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address I License # I <br /> ELECTRICIAN // , Company / • r C iYC -/-v- I C <br /> Signature Azad !z( Registered - N F ee Current Y / N <br /> Address 3 9 /// j _ Q _ - 7 7 5 r e i z j A Y / s f' 1 33 5'V O I License # I EC- DOO/ 268 W137 <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I License # <br /> OTHER Company <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address. License # <br /> .: �; <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.pascoaov.com) <br /> • <br />