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813 - 780 -0020 City of.Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received J I Phone Contact for Permit <br /> Owner's Name `■/ I 1 1 11 I <br /> ./ /I ::141 �� Owner's Phone Number <br /> • <br /> Owner's Address I . / i ,� 4 �i� � i 1 i /'//r/ ?,j2- ?,j2- J <br /> Fee Simple Titleholder Name / Titleholder Phone Number I <br /> Fee Simple Titleholder Address I <br /> _ , .:: °° for a„ ::`: 5 •$taireM � s�. �"' TtegnamYa.mm.s�t:5?�..s'�`z�zF". >...: <br /> Job Address I <br /> Lot # <br /> Sub Division Parcel # <br /> „ : : :- s,YF R. e .w -MN= ' . i *' , 'a ;, feu �y STOMP ,, ^ , E • .: '. MA a" fi Mfiti; ... 1 ?sr A .ltM6 <br /> El Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> JQtrlyl (Semi FFTII Other <br /> � Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ ( I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 1 Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> Y ,,, if...m..� .arias czumor :' ..o,.: ., .. ., .; k e. + reafi. "".f "aa� - xwll-mw zi:":�.: ata t ,am a ttemaz . e�4:' en�aw+. ivis l <br /> Contractor ' CIMIII% Company <br /> Signature .� �`/ i Registered Y / N _1 Fee Current I Y / N • <br /> Address I License # <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company I <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 . 1 Fee Current I Y / N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y / N f <br /> mem Address I License # <br /> ., .,...,.. ....: ,... .., „,M.,n: ;:� � .N.�. '”- a m . °LL:L.L:1..,.,. a <br /> Directions: d��,,w <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 />