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813 -780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received <br /> I Phone Contact for Permit 1 1/1 I i 44 4 2 I I I g q 3 <br /> Owner's Name 5 ''(ec 4- P A 5o; ( A -?/ G) S/ Owner's Phone Number 1 1 i <br /> Owner's Address l It' �y t o k IU - / 4 ; ,,' fe 3 d ( /'/m 74, ., I/ Kg C <br /> Fee Simple Titleholder Name 1 Titleholder Phone Number <br /> ■ <br /> Fee Simple Titleholder Address I ' <br /> . - <;.; .. ;'3;..; =F.. s� _.�.s -- -_ ,,.: .:x�:. r� '- 5�- ,�,:.a- i:;'� - _�'"" sue,.. ,.� s :. <br /> Job Address 6 g3 1 A, 2C.. / (//top- /. l/ qYI /A, r/S i/ J Y5 y/ Lot # i <br /> Sub Division <br /> Parcel # <br /> : � � :�• .:max �., � <br /> E Bio- Hazard Waste Storage - ANNUAL r Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> E Comm Exhaust Kitchen Hood /Duct r Hood Installation <br /> El Controlled Burn El LP /Natural Gas - Installation <br /> E] Emergency Generator < 30 kw I LP /Natural Gas - ANNUAL Sale <br /> E Emergency Generator> 30 kw r Places of Assembly-ANNUAL <br /> © Fire Protection Maintenance - ANNUAL = Recreational Burn <br /> �QtrlyI 7, Other <br /> Sprinkler ci ❑ ❑ �❑) = Sparklers <br /> L.L_ <br /> Fire Alarm ❑ ❑ p9 I I n Sprinkler System Installations /' l r( <br /> � ( Hood Cleaning E ❑ ❑ ❑ I I Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I I = Torch Roofing/Tar Kettle , <br /> Ii Fire Alarm Installation El Waste Tire Storage ANNUAL - - -- - <br /> B Fire Pumps <br /> Fire Works <br /> El Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> Other: I <br /> = ~: cry a te.. _. .. <br /> Contractor , 11' ,- Company A — r0 #c I SG alt .k'1'On , re. <br /> Signature / ! 4, Registered Y/ N J Fee Current I Y / N 1 <br /> Address I 35 31 lhel ,54-mnQ. Rd. I License# ( E F 0000 1144 1 { <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N j Fee Current I Y / N 1 <br /> Address I _J License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I <br /> License # <br /> Directions: <br /> FiII 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 />