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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit 17,? 'Y 119 y 2 I I 1 q e13 <br /> Owner's Name 0 / 3 1 I 5 <br /> - e U r !/I r ' / S 9r k A./ n S / )m46:4) Owner's Phone Number I g" 7/ 11,6-00 I <br /> Owner's Address 7 Pf lt., <br /> f s/r) e 9/ She . /D / I <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I I I I <br /> Fee Simple Titleholder Address I <br /> 7 o r, ry <br /> Job Address 1 7 3? 3 • ✓1 re f, J / / - n ...;, Qf S/e • /0/ I Lot # <br /> Division <br /> Sub Div i on <br /> I c / <br /> Parcel # <br /> ..: ::' •.i:'.�? 'i.: �,: -: .R.i. :o- :.: ._b,: 4,;;� �+ua '. p <br /> 0 Bio -Hazard Waste Storage - ANNUAL I-I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct I Hood Installation <br /> ED Controlled Burn JJ LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw n Places of Assembly - ANNUAL <br /> U Fire Protection Maintenance - ANNUAL r <br /> Recreational Burn <br /> 0 1Qtrlyl 1Semi ) (iuj !Other ❑ <br /> Sprinkler ❑ ❑ ❑ Sparklers (� <br /> ® I [] r / ` <br /> Fire Alarm ❑ ❑ Sprinkler System Installations / � ) V! <br /> Hood Cleaning ❑ ❑ ❑ I u Standpipes (Sprinkler Sys) <br /> Hood Suppression IJ ❑ ❑ ❑ I I El Torch Roofing/Tar Kettle - --"° <br /> n Fire Alarm Installation I Waste Tire Storage ANNUAL <br /> EJ Fire Pumps <br /> n Fire Works <br /> I1 Flammable Application- ANNUAL I <br /> Eli Fuel Tanks I Valuation of Project <br /> n Other: I <br /> Contractor I Company A ,^ <br /> Signature �'G SG tU : - re- <br /> Registered Y / N j Fee Current I Y / N 1 <br /> Address 3531 1'+ AA I License# EF O000JIM 1 <br /> ELECTRICIAN' <br /> I Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> PLUMBER I I Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I 1 License # <br /> MECHANICAL! I Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address <br /> I License # I <br /> OTHER I I Company <br /> Signature Registered Y/ N J Fee Current I Y / N I <br /> Address 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 />