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813-780-0020 City of.Zephyrhills Fire Fax - 813780 -0021 <br /> Permit Application <br /> Date Received <br /> Phone Contact for Permit <br /> Owner's Name I / 74 ,.,���s7" : 4y . 64 Owner's Phone Number I c" 3 1 17 - ' 1 I C4j d l <br /> Owner's Address 3,4 ! y s -- sir z y ,,,2, to K <br /> Fee Simple Titleholder Name Titleholder Phone Number f 1 I 1 1 <br /> Fee Simple Titleholder Address 1 <br /> _.�. ',. i''ua.. 'k"a:s':'fA':" #' ;.✓',s, Etr&�:: .= us'= ;,:vkx.s,z -�. .':r„fiax�v_c' a, <br /> ` :. e °9 �xn6N+i "��w r�.". a ':�/i�?�`k^e��.�a'.pa�..�..•- K. <br /> Job Address Lot # I J <br /> Sub Division Parcel # I <br /> ,mtrammeigemBaum::'x:a.a n{ar??fivla, % : :, ,, ,'9s z -;"x, :»i <br /> ' i s a : =' k t r .; >., -w-* 1^• A .:.. off.° <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I <br /> I I Controlled Bum 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 Ti Places of Assembly- ANNUAL <br /> �(Qtrlyl (Semi (I Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I ( I I Sparklers <br /> Hood Cleaning ❑ ❑ , I <br /> Sprinkler System Installations <br /> Hood Suppression IZ ❑ IfES ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL <br /> II I ri Valuation of Project <br /> Fuel Tanks <br /> n Other: <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N J Fee Current I Y/ N <br /> Address 1 I License # I <br /> PLUMBER Company 1 <br /> Signature Registered Y/ N ,I Fee Current 1 Y/ N j <br /> Address I <br /> 1 License # <br /> MECHANICAL Company <br /> Signature <br /> Registered Y/ N _I Fee Current 1 Y/ N j <br /> Address I I License # <br /> OTHER Company -('u -,7 /_��E e cr u p,,,,r 7 14•C_ Signature C3-7/) <br /> Registered MEI <br /> 9� ��� Fee Current <br /> Address License # 7, 6 : / <br /> Directions: d�.�,�. . >:, , t� <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 /> • <br />