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f <br /> 813-780-0020 ( / t2 City of Zephyrhills Fib Fax- 813 - 780 -0021 <br /> Permit Application <br /> . <br /> )ate Received r A Phone Contact for Permit rj 1 1 1 1 <br /> )wner's Name IC , A • 4 • .e. . ILA \l er's Phone Number 1 7/3 7 <br /> hvners Address l ( , i:‘! r. ( 'P 1 1' r 1 1 �j F l 3 3 5 <br /> =ee Simple Titleholder Name I Titleelder Phone Number ` 1 / I <br /> =ee Simple Titleholder Address I <br /> r ,4't ..:,., : ', r' • _ ',' . .r.u: 4,:4 ., : ..r , ,, f ? : ` <br /> mow: `.�� <r�s ,..,.- - s : � . <br /> Job Address it Yr-�� Lot # Soo e ,,, <br /> Sub Division 0: t L (') L Z e ' � `ys US , / l Parcel # - a ( " ail rn 'a9 �xzx7 <br /> .�� �'^ ...••4 , -. <br /> n Bio-Hazard Waste Storage - ANNUAL 0 Fumigation Tent <br /> E Comm Exhaust Kitchen Hood/Duct 1 1 Hazardous Material (Tier It or RCI Facility) ANNUAL. <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I ( LP /Natural Gas - ANNUAL Sal / �9 <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly-ANN <br /> U/4L 41 J (/ <br /> ml �SemiJ 1""' t Uther // <br /> .,r/ <br /> Sprinkler n ❑ ❑ 0 n Recreational Bum <br /> Fire Alarm ❑ ❑ A l n Sparklers C/4 <br /> Hood Cleaning 0 ❑ ❑ ❑ l I 1 Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I 1 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 { Valuation of Project <br /> I Fuel Tanks <br /> 0 Other I OA <br /> _ *. -.i, a ;' <br /> Contractor s ���� <br /> Company o r( V 5, <br /> Signature h t : A Registered 1611314311 Fee Curren [ ®1111 <br /> Address G • Gt � . . , ► ___ _ � <br /> �T vuzis- License # I E F 1 00 U (0 Li 1 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current Y / N J <br /> Address I 1 License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I 1 License # <br /> OTHER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address Li # <br /> ",!.'-_'pit 'rete sm`._...�'' ..„ „ — --4- .,..... a - .. ..X.M: a:4�u vo, .......m..,.. .tuaatarta ....._.. .. - : � n�, Z :.._ s__.,... graE'Lf".E3 <br /> Directions: " `W" ` —� .. s <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) <br />