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' 813 -780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I Phone Contact for Permit 1721 1 14 Li Q 11 q q <br /> Owner's Name 4 aka 5 j4 (� / (,. ` , C l Owner's Phone Number ! js 0 f 3 l (7( S b5,Cj/ <br /> 0 <br /> Owner's Address `'' O 1t ,4 (/ i Zef A /A F( 3 3 $ ' 0 <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Slmpie Titleholder Address I <br /> Job Address 7 J q W 1/ / e Zt° /� ` 4,,i ' I( 3 35c Lot # <br /> Sub Division <br /> Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood /Duct J ] Hood Installation <br /> Controlled Bum El LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator> 30 kw 1 Places of Assembly-ANNUAL <br /> © Fire Protection Maintenance - ANNUAL a Recreational Burn <br /> Qtrl prim y (;TjU Other <br /> Sprinkler Ei ❑ ❑ ❑ El Sparklers l <br /> Fire Alarm ® ❑ ❑ A7 1 1 n Sprinkler System Installations . !� <br /> Hood Cleaning Ei ❑ ❑ ❑ f Standpipes (Sprinkler Sys) rrll <br /> Hood Suppression 0 . ❑ ❑ ❑ I I Ei Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation = Waste Tire Storage ANNUAL . <br /> I Fire Pumps <br /> ® Fire Works <br /> Flammable Application- ANNUAL <br /> 1 1 Valuation of Project <br /> Ej Fuel Tanks <br /> n Other: I <br /> ;. <.. _ ,._ - i;__.rc.._. §__.,..,a :. __, .__� _ w -x.,- ? = :t- '` ., a ... . -:s., = ::...,._ > .s__, .- --- .. . .... ... _ <br /> Contractor Company A — r 9 -1„:,‘ So (u 4 -'on . tine- I <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address I 35 31 VI€9.5A - one- Rd. I License# I E.F000O i I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I <br /> I License # I <br /> PLUMBER <br /> Company I <br /> Signature Registered Y / N 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I 1 <br /> Address 1 <br /> License # I <br /> OTHER <br /> Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I License # I <br /> Directions: I <br /> Fit out application completely. <br /> Owner 8, Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over S2500, 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 />