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813-780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received I 1 Phone Contact for Permit 111 1 I 444 2 t g q 3 <br /> Owners Name j MINI, , �2 , 0 -)- r' et r - ' Owner's Phone Number l C5/(3 1 3 f ?Q f I <br /> Owner's Address 1 / ) 1 (4l (y / /40 Id G f/ 7 ? F I 3 3 ,SS <br /> Fee Simple Titleholder Name I , Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address � 3 2 �( d /(^ ( 0/ PGv G� <br /> z 4,47, T Lot # .. <br /> Sub Division Parcel # 1 <br /> •s:: ._.. .:. _...w ,i•eg i.kisi _;,...'v.u.s ;:,, ..'web. .a.,._.:,m yew s's: =_ _ _. _._ . .... . <br /> ED Bio -Hazard Waste Storage - ANNUAL El Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> Controlled Burn LP /Natural Gas - Installation <br /> E Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw Ei Places of Assembly- ANNUAL <br /> © Fire Protection Maintenance - ANNUAL L.__..I Recreational Burn <br /> ry ems (;l Other <br /> Sprinkler ❑ ❑ ❑ D Sparklers / 7 (_ <br /> Fire Alarm E ❑ ❑ XI I n Sprinkler System Installations ,/ / - <br /> Hood Cleaning 0 ❑ ❑ ❑ [ 0 Standpipes (Sprinkler Sys) ' ( // <br /> Hood Suppression 0 ❑ ❑ ❑ I ( LJ Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation = Waste Tire Storage ANNUAL <br /> El Fire Pumps <br /> Fire Works <br /> El Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> ,� <br /> - -� ., ..:. : _. .�._� �,_.1 .� � Z - .�____.La <_ _ a � tg,6tEn.g Oyu — , � .�_.e,,,, _- _ ...- . <br /> Contractor Company A 'T" 4-o ( So (u 4'1•on . hG I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address J 3531 1 e9 ,4•13n Rd. j License# E. 7' 0000 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I n License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address 1 I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> 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 />