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813-780-0020 -, C , <br /> lotiv ! City of Zephyrhills Firs Fax - 813 - 780 - 0021 <br /> A , , Permit Application <br /> fr <br /> )ate Received • - Phone Contact for Permit <br /> . ,. . - , ..:� _:...;.< .:.... . ......a .,- .,..wa. ...,.....�...... u_ <br /> )wner's Name ril r • r Owner's Phone Number <br /> )wners Address 1 1 1.0 1 &d B 1 t) Z e_elAir k. �Ls \--1 3 3 5 y a. <br /> • <br /> :es Simple Titleholder Name {{ 1 Titleholder Phone Number <br /> :ee Simple Titleholder Address I <br /> -.. <br /> Job Address I Lot # <br /> r Parcel # - d5 • XI tY - c400a - 00(0 a <br /> Sub Division .n - '"��......�a.�.`,.: <br /> n Blo-Hazard Waste Storage - ANNUAL Ei Fumigation Tent <br /> El Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ED Controlled Burn ri Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation , c.___ :!: y / 1 7 ' <br /> n LP/Natural Gas - ANNUAL Sal / / <br /> Emergency 30 kw <br /> Fire Protection on Maintenance ance - ANNUAL n Places of Assembly -ANNUA r <br /> �; Isemr1 raj timer __ <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum 11"..' w /� <br /> Fire Alarm ❑ ❑ %I I Ei Sparklers / <br /> Hood Cleaning ❑ ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Suppression [J ❑ ❑ 0 I 1 n Standpipes (Sprinkler Sys) <br /> 0 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> R Fire Pumps n Waste Tire Storage ANNUAL • Fire Works <br /> Flammable Application- ANNUAL J Valuation of Project <br /> Fuel Tanks <br /> fl Other: 1 <br /> Contractor Company O ,5 <br /> S ' <br /> Signature j ���Z�'L'A <br /> ) s � ' Registered maw Fee Current ir <br /> Address I • 'P . lialtr ;l• - License # I p F ( C) ( 0 Li i 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y i N <br /> Address 1 I License # 1 1 <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I ( License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered _ Y / N Fee Current 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 : /lappraiser.Pascogov.com) <br />