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813 - 780 -0020 City of Zephyrhills F lre Q rax -o -r ov-vvc i • <br /> Permit Application 2 ' -_ . - <br /> Date Rerrived Phone Contact for Permit 6131 Lsz il 1 . <br /> Owner's Name 1 kt V I L.4) AETh 4 L Lit_., Owner's Phone Number I 1 I <br /> Owner's Address 1Zs C ON514'00'ar•K -6. S•7'/4'Y6 12b , Wk." wig toY71 . PA- 190f, 4Z t17i <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 <br /> Fee Simple Titleholder Address <br /> Job Address 1? WS GAth. R.: Po1i I+LU.s , r.{. Lot# <br /> Sub Division Parcel # 3S • LS • &! • 0010 • 01!<$oo • 0000 <br /> Boum <br /> El Bio -Hazard Waste Storage - ANNUAL = Fumigation Tent <br /> E Comm Exhaust Kitchen Hood/Duct I-1 Hazardous Material (Tier II or RO Facility) ANNUAL <br /> 0 Controlled Bum r--i Hood Installation <br /> El Emergency Generator < 30 kw h LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> r y e91 ® Other <br /> Sprinkler 2 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning E] ❑ ❑ ❑ I ( n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ 1 I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I.1• p0 ' Valuation of Project <br /> Fuel Tanks <br /> Q Other. 1 I <br /> samassainassammenesseassem <br /> . ,. ... <br /> Contractor Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # ( I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y' / N I <br /> Address I 1 License # ( <br /> OTHER el . company /QO hd Mme. s mixtetvs ,,,,,t. Signature � Registered CP / N I Fee Current I Y / N I <br /> Address r 22111frj, L License # G g S/' Loon // 99 9 <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 (httpJ /appraiser.pascogov.com) <br />