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813-780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received ( 1 Phone Contact for Permit 1121 1 . I 91 4 2 11 t q <br /> Owner's Name gr iirtr.�liallit Q / ' WOE Li j 1(,/Dwner's Phone Number 1 / 3 733 9�o <br /> _ <br /> Owner's Address r .5 f / 5J . C 0 e r - f (/Ti 71-;/r‘ // N /lie P K cAc/ /ot V , ;#23° 3 <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> Job Address 4 ! 3 /t1 c"4'(Ca ( U. e w w -e j f 3 3 5 / ( Lot # <br /> Sub Division Parcel # I <br /> - ,: _ _s rr.w.el: : ;-t.:,:2,_.,; _ .. ,..o ._err .& _ . .m _a,E_:: _.t......m�� = �_ -: _,:�� • �-a� _r ._. . . <br /> D Bio -Hazard Waste Storage - ANNUAL a Hazardous Material (Tier If or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> El Controlled Burn ED LP /Natural Gas - Installation <br /> E Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El � Emergency Generator> 30 kw n Places of Assembly-ANNUAL <br /> ^ <br /> ' 1 Fire Protection Maintenance - ANNUAL Recreational Bum <br /> ry prim Other �F <br /> Sprinkler El ❑ ❑ ❑ El Sparklers J <br /> f <br /> Fire Alarm ® ❑ ❑ I 1 n Sprinkler System Installations ; /°61 1 Hood Cleaning E ❑ ❑ ❑ I I E Standpipes (Sprinkler Sys) / <br /> Hood Suppression 0 ❑ ❑ ❑ 1 I E] Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation Q Waste Tire Storage ANNUAL <br /> R Fire Pumps <br /> Fire Works <br /> lJ Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> El Fuel Tanks <br /> n Other: I <br /> : = =s - ,: <br /> Contractor Company A - T .},a 1 So (u :k-Von , tine- I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I 35 31 lh ¢4 .54•ene. PtcL. 1 License # ( E. V OOOO yL+ 1 I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N _1 Fee Current I Y / N <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current I Y/ N <br /> Address I 1 License # I I <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address 1 1 License # <br /> OTHER Company I <br /> Signature Registered Y / N j Fee Current ( Y / N I <br /> Address I I License # <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 />