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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 Permit Application Date Received I 1 Phone Contact for Permit 112'} 111441 I I i g 4 3 Owner's Name Ye et/ 1-/F (A [-i r k /77n-O! 6,/ f I Owner's Phone Number 19/3 let Owner's Address 1 1g Pe, i Dr. Ze f � y A / (C pi. 3 7 57 f Fee Simple Titleholder Name I // / I Titleholder Phone Number I I I I I Fee Simple Titleholder Address 1 Job Address ("TPA' Ff.. 2 e 4 r/ / //s -/ - 3 35Y) I Lot # I Sub Division Pa Parcel # ri Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL n Comm Exhaust Kitchen Hood /Duct n Hood Installation ri Controlled Burn n LP /Natural Gas - Installation El Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale I - ( Emergency Generator> 30 kw E] Places of Assembly-ANNUAL 71 Fire Protection Maintenance - ANNUAL ni Recreational Bum (,J eml gm ter Sprinkler n 1 ❑ ❑ 1] Sparklers � /J Fire Alarm CI ❑ ❑ ❑ I I I Sprinkler System Installations r F! Hood Cleaning 0 ❑ D ❑ I 1 I I Standpipes (Sprinkler Sys) Hood Suppression ❑ D ❑ I I I I Torch Roofing/Tar Kettle n Fire Alarm Installation I I Waste Tire Storage ANNUAL n Fire Pumps 7 Fire Works n Flammable Application- ANNUAL I El Fuel of Project Fuel Tanks Ei Other: I Contractor I Company -- o{G S Signature R r C Current o� c. 1 Registered Y/ N J Fee Current Y/ N I Address 353, 111e454.one, ( License# gg 35 3 g000 lap02, I ELECTRICIAN I Company I Signature I Registered Y / N I Fee Current I Y / N I Address I I License # I PLUMBER I I Company Signature Registered Y/ N I Fee Current I Y/ N I Address MECHANICAL I License # I I Signature I I Company I Registered Y/ N J. Fee Current I Y/ N Address ( I License # OTHER I Company I Signature I Registered Y / N j Fee Current I Y / N I Address I I License # I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)