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/ <br /> 813 -780 -0020 City of.Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit j I <br /> Owner's Name �irve c - 57 4 MN)) he P-431-1,9. Owners Phone Number I )3 I 1 //a <br /> Owner's Address 10LY/ /JC,m ?t > ) e ± <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholder Address ( <br /> aro " :::t... .. t ,. :,a R . s: ° . ' _ itiMOR i n, .. WA ;tag . r .,��_ �..u' .a �" =... . <. .. ,. <br /> ., � "^ yv dew <br /> Job Address Lot* <br /> Sub Division Parcel # <br /> , :. ...;ommorm agrm3;"inKR' to twg ,y c ` ,,, gt , :“ :. fit:int`. y OMMI MMiliirtrg n�. €€kMgb l " . ggiaga: "k,* . eiNgi w r.,r.K:.x<a«adigM d,a, <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 /> fJ Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL ) <br /> �� n Places of Assembly- ANNUAL <br /> 1Qtrly1 )Semi) I 1 Other � <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ I n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ 1 I I 1 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 /> El Flammable Application- ANNUAL I I Valuation of Project <br /> I Fuel Tanks <br /> Q Other: I <br /> Contractor � - y Company <br /> Signature 1i\ �, i ■ � ..4 .. 11 lD 0 I t Registered Y / N I Fee Current I Y / N <br /> Address I 1 I License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y / N I 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 <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y / INLI <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> wm,olo.;.. se.<I,°: .,w.m„.::..:.,sK,crs..�.w,,,,. ,,vaua�s�.ca.,ueu ,. a:. N•..s:. .w.w �, ...,hi,,,K '"`sue;- 'S7: _ 4< 0.s = " -u. ........;w.vs �3.. ,,...A se c. <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 />