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813- 780_0020 City of.Zephyrhills Fire Fax- 813 - 780 -0021 <br /> • Permit Application <br /> Date Received Phone Contact for Permit <br /> Owners Name I I'� % " C e . .- 5... —� j Owner's Phone Number I 11 i3 <GT <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> s.: c m ..">: "mimUMM graM7 rw " _.Ma MI ';r .. `t' ? ;• e i .. ?asµ:. : T'a ; � w4 v:?'ffigf WP aiRal na . arn .c K,],t =i gAlt : <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> ...? 11MSI MISO.,�" "r`�r`:.• : w. etreiiklM ' : AMAL ... , �'ZIM a:` 3.d f iti;.: .,.,M �<:. 45,%:<=4: . <.< ra<." i a s ' AMValeid <br /> ,,�, '4� ,C <br /> µ _P.: .. .,: �.., ^�- �z.au:�, ASS. a�: �. „ . �« � "�k�:a'�i9.�e:kde�:i�.�."��.aCk < <br /> r----1 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 n Places of Assembly - ANNUAL <br /> 1Qtrlyl [Semi' Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ID Li I I n Sparklers <br /> Hood Cleaning { iv ❑ ❑ I I Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ 1 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 l ( Valuation of Project <br /> ri Fuel Tanks <br /> n Other: 1 <br /> Contractor <- ' �� Company , iJ c_.... �,. _ ., - Imam <br /> T� "j� —- _ <br /> ... - ,- <br /> Signature j� % '" f istered Fee Current 1 1 / N <br /> Address I$C/Sf w f ,,./ J `7'/ " �1 t / J� e:1* C' L f License # ( I <br /> ELECTRICIAN / V Y Company <br /> Signature I Registered Y/ N f Fee Current I Y/ N I <br /> Address 1 ( License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N j 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 j <br /> Address I I License # <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 License # I <br /> a.. & asa r�. a°.;.. nrsea :s.1;xw.r:�Sv?" r.... ..,as...u::..,r,z...�.�a ~.s+..� .......,��ah; I <br /> Directions: ;.tea= �;; <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 />