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813 - 780 -0020 City of Zephyrhills Fire Fax - 813-750.0021 <br /> P ermit Application <br /> ffit. 4n1 t 7t� - -/� 11 I <br /> Date Received Phone Contact for Permit <br /> Owner's Name rrE Uq I /4,0 t'..Qf2Rc)R,PQ flO n M <br /> V.) Owner's Phone Number 1 8-0 h53 15 <br /> Owner's Address 01(47 1 5 S :Ina 1,J,.S -�( tlC_, 1 ll uk, GJ <br /> aIfa. —r Mn 6 a Q c�S a t Z <br /> Fee Simple Titleholder Name R. Sse- 11 - L - cri Titleholder Phone Number L N . 0 S3 Ist.4L4L <br /> Fee Simple Titleholder Address 2 - (4) 1 5 S tn3 �S..rtak �[ n a o� 00-...52- —T R 5 � <br /> Job Address K m 3'1b — 1 1 -1 22_ c Nu.. VI yr ?_.e.ph� (h l is q-1 2S'Cfft I <br /> Sub Division Parcel # 1 <br /> n Bio- Hazard Waste Storage - ANNUAL 1 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Burn n LP/Natural Gas - Installation <br /> a Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> 1 I Emergency Generator > 30 kw n Places of Assembly - ANNUAL 4/9 7 <br /> n Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> 1Qtrly1 jsemi1 yj Maw <br /> Sprinkler ❑ ❑ Ir. LJ Sparklers <br /> Fire Alarm ❑ ❑ M I I 1 Sprinkler System Installation <br /> Hood Cleaning n ❑ ❑ ❑0 I I ri Standpipes (Sprinkler Sys) <br /> Hood Suppression E ❑ ❑ ❑ I 1 U Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation I I Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> n Fire Works <br /> ED Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> Fuel Tanks <br /> n Other' <br /> • <br /> A i'l' 1 <br /> Contractor ( may � 'L(q r Company a A Ifs.) C�OR�Q ¢ <br /> O .�T1,Cot. I <br /> Signature Registered n / N f Fee Current 1 Y/ N I <br /> Address I <br /> I License # ( I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address I <br /> I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N . 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL <br /> Company I <br /> Signature Registered Y / N I Fee Current 1 Y/ N I <br /> Address I <br /> 1 License # I I <br /> OTHER Company I <br /> Signature Registered Y / N J Fee Current I Y/ N 1 <br /> Address <br /> License # <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 - days for review after submittal date Parcel # - obtained from Property Tax Notice (http./ /appraiser pascogov com) <br />