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813 -780 -0020 City of Zephyrhills Fire j �'1 Fax- 813 - 780 -0021 <br /> . Perrnit Application <br /> Date Received 7 --/g 70 Phone Contact for Permit ) 32 1 / vc, I <br /> ...::. E: ^a�:�i9 ..- sxsn4i .. N.iwau uFt` >.e . ......,....w '. .w� . ,» uv.. w •`w,.on..�.u.«w.u'a«::.k$��fWFF >A..,3:�mE.a .�z..:sa%�$h...��.atu"F:$... ,�.,zc'T,�'..:h .... Ce e.n 4 . 5.... sl:. ml.- �a' vcw .ir�R....az...o., >.«s...w».. : <br /> nmXcanaxv.vace r �M"..s rk wxn. a., w.v..mv <br /> Owner's Name [ Cans ') n S ,.1 Ver I Owner's Phone Number I <br /> Owner's Address 7 4 1 (_Q, 1 f? i U a <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> M ., MME M V, ; M,.,ZS LI ;:.:. >.e L' A " ? _ V,.... . k "'tr ?S' -, Ffi� ... MERE .. IN r grail �o ?t mis'a � '� > ��...�:. g M. 3.... . <br /> Job Address _) 4 1 ) C.--C\ l , U ((/ Oi - Lot # <br /> Sub Division Parcel # <br /> s'tAM. s, acilm ar �'"."*g .. .. r aggi a ....�.�.� octive.,e� mum N- tia ti a arA0a4:, M .M..us e"' ..z, vr.�.�iti f ng.t.i',.Z ri. <br /> C W <br /> n Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct l I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> FT Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IQtrlyl 'Semi' Ann Other <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning p El ❑ I I n Sprinkler System Installations <br /> Hood Suppression " t q� ❑ I I h Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation !/ n Torch Roofing/Tar Kettle <br /> FT Fire Pumps n Waste Tire Storage ANNUAL <br /> E Fire Works <br /> n Flammable Application- ANNUAL ( I Valuation of Project <br /> n Fuel Tanks <br /> FT Other: I <br /> aE6.1 ..A r VEMSV sin , M u sOZAvigx M Ng€?a =a te ,a.,", imatamtmargin llama zw w,n_= <br /> Contractor Company 7C C Leas 1 `, 3/1-4k L� <br /> Signature Registered Y N 1 Fee Current I Y / N j <br /> Address I -/2c /11414o r ^. 111 em% 1 - X S / 4,Ed FZ -I P-941Rense # I I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N J Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I 1 License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # ( I <br /> OTHER Company I <br /> Signature Registered Y/ N j Fee Current I Y/ N j <br /> Address I I License # <br /> ,.. >,M� tea°'. _ —".�m _M M ��,r� v.:�aEL .M._.u, „gr...«..gg <br /> Directions: <br /> Fit 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 />