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813.780-0020 <br /> City of Zephyrhills'Firz 44 ( Vt9 1 Fax- 313-780 -0021 <br /> Permit Application <br /> Date Received _ ._ _ K <br /> ... a. <br /> �x mss.. <br /> Phon Contact for Permit � <br /> - =�`�" ° -��-.� . �-- -.,.�_ �w �:.� .�,�.:� -- _ L �.�Q l� ( !fi ►'��� ✓�ilt'Owne�s Phone Number I X 81 3 H � 6 2 6 5482 <br /> Owner's Name 1 STMPT,RXGRTNNELL <br /> Owner's Address ( 4701 Oak Fair Blvd TAMPA FL 33610 <br /> - 1 Titleholder Phone Number <br /> Fee Simple Titleholder Name <br /> Fee SimpleritleholderAddress ` • �? d <br /> Job Address -- 7()5 t? l ".tril \t 1?- \QA. • 7 P 9voA rin ►i1 S I- 3 c� + Lot f# <br /> I Parcel # 1 <br /> Sub Division 1 <br /> 1 1 Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> 1 1 Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier 1I or RQ Facility) ANNUAL <br /> Controlled Bum Hood Installation . <br /> 1 1 Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> LP/Natural Gas - ANNUAL Sale <br /> 1 . 1- Emergency Generator > 30 kw <br /> Fire Protection Maintenance - ANNUAL - ' . Places of Assembly - ANNUAL . <br /> 1. 1 Lim Isemil 'Anil !Other <br /> Sprinkler, IM ❑ ❑. 1 f 1 ` Recreational Burn <br /> Fire Alarm ■ ❑ ❑• (• , 1 1 1 Sparklers • <br /> Hood Cleaning 0 '! ❑ ❑ I ( 1 ( Sprinkler System Installation <br /> f Standpipes (Sprinkler Sys); <br /> Hood Suppression - 0 / I, . -� 1 ` • <br /> ( Torch Roofing/Tar Kettle -.•__ - -- <br /> 1�_ Fire Alarm Installation ! _ _ <br /> P Waste Tire Storage ANNUAL - <br /> ` 1 ; (. Fire Pumps __ • 1..1„ I • Fire Works • ' . . <br /> Flammable Application- ANNUAL <br /> Valuation of Project <br /> Li y� <br /> . <br /> ' Fuel Tanks <br /> f / <br /> I �- v ^7 ` r Other rh I r►.v c� f , • 'J • � � I r tt <br /> 1 , yP�n�.,..{ �- �:: 3a. :uSz�S�?.��;� <br /> Company 3 fyrl -r �,•Frrr� -e. t( <br /> Contractor _ ' <br /> Signature Registered Y / N Fee Current 1' Y / N 1 <br /> . <br /> , 1 License # <br /> ELECTRIC Compan y <br /> Signature . _ Registered • Y/ N 1 Fee urren 1 -- : Y/ N .1 <br /> Address 1 1 License # 1 ,. l , <br /> PLUMBER Company . •.. <br /> Registered L Y/ N' 1 Fee Current 1 Y1.1.1 . • <br /> Signature I <br /> • <br /> Address 1 • 1 License # , 1 ` t <br /> MECHANICAL Company <br /> Signature Registered L Y/ N Current Fee Cuent L Y/ N 1 • . Address 1, -. _. 1 License # 1 1 <br /> • <br /> • <br /> OTHER Company . <br /> Registered Y/ N 1 Fee Current 1 Y / N i <br /> Signature <br /> License # <br /> dress 1 <br /> $'�'�11"f Ad �hYSn�r�u• ' <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 (httpJ /appraiser.pascogay.com) <br /> • <br />