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813 - 780 -0020 City of Zephyrhills Fire 010 i 4 i <br /> Fax -813- 780 -0021 <br /> ` Permit Application <br /> Date Received I Phone Contact for Permit 1 I <br /> `t ..>;: ' � � .0 e :e PW1w. .• xRS^ w�xa.. x...... ja. ;wu�"Kxx�..,...�.:'�:.�h..�.... ra ...... ..... .... .o, .... M•„o.,sx.._i,s M.axx4. ". .kw...e......«x....w, <br /> Owner's Name I fjoat�- 7 1 0 Z [TR\\ Owner's Phone Number 5/ 3 7 g( 7 <br /> Owner's Address 3 g Z 2_0 A€ N a-y- DJL, V (_. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholder Address I <br /> Job Address 7D 7-2O CTor,/ {L�/ ■'\.1 0 C Z \ `\ Lot# <br /> Sub Division I Parcel # <br /> . • ' 5 emgam ,' my w a a ^; sFx a =', mr &W,V,AIN aAN : N, , ' i'4.. - rgre, d a ri MWN :mtiC i :vv ie,w,.c"na. .eo.imara.m: - <br /> n 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 /> El 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 /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IQtrlyl Ferli WU Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project 11 <br /> n Fuel Tanks <br /> Ti Other: I <br /> z a..,'...a:".�3 ...M,?. � ''" x M €'F?ws's.. °. N . .::',..., � a . w�`'°:a� . - 'zr . ` A, ';tea �' sE 1. :.r, ;''.1'4,,, , s`.' ."taia=m::w"�sk'""a�iX . a a .. ',niza..s:''� I <br /> Contractor r Company Ev c -c-e..44' 1 f- I t- <br /> Signature �' �� �'`( k S` L''` `� Registered ('Y / N I Fee Current I Y / N <br /> Address 1 it ‘61 hl $ (.(t{ 7 I License # I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address 1 I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I License # <br /> it M tn <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 />