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813 -780 -0020 /' City of Zephyrhills'Fi <br /> Permit Application Fax-813-780-0021 <br /> )ate Received <br /> Phone Contact for Permit <br /> W, W.. .... ..M�._ <br /> aP .,... A ' (I �j ate <br /> )wner ,7 <br /> s Name v 1r1 )/ ► , r Owner's Phone Number lLl Cl / 3 j 17 d l, l (QJJy <br /> )wnersAddress ` tO . 3 ‘k b VA . ,e-Nc 2e e \'s1,`S 1 3359 -- <br /> =ee Simple Titleholder Name I Titleholder Phone Number ( I <br /> =ee Simple Titleholder Address I <br /> Job Address 1 Lot # <br /> y Q I�4� � � <br /> l S P arce l # 103 • AG, a 0100 - 00:307 - f)000 <br /> Sub Division l <br /> n Bio Hazard Waste Storage - ANNUAL E Fumigation Tent <br /> ID Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Burn I Hood Installation <br /> I - I Emergency Generator < 30 kw El LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LPINatural Gas - ANNUAL Sale /� 516 Flre Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL / v <br /> L.7F7 t�ii 1 ma Unbar <br /> Sprinkler I—I ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm E ❑ ❑ i I I a Sparklers C ) <br /> Hood Cleaning CI C3 I 1 1 Sprinkler System Installations VV <br /> Hood Suppression D ❑ ❑ ❑ I I El Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation I Torch. Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> • <br /> Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> n Other. <br /> Contractor 1 Company S . -. .1�� eitec, 0 4 — 5 . <br /> Signature 1 1 _ Registered 16120111 Fee Current N <br /> Address • ' L_ ( • `'Tmi+-^•�darU: License # 0 D O t O y lQ 1 <br /> sLECTRICLAN Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I 1 License # I ( <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I J License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I 1 License # I <br /> OTHER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I License # <br /> i, . -. v ...-- . a ,... - ..,._.. - .,ri �.� _�:c <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) <br />