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813 - 780 -0020 City of.Zephyrhills Fire Fax -813- 780 -0021 <br /> - Permit Application <br /> Date Received 1 Phone Contact for Permit <br /> ND/ 1 I 11 1 <br /> � �., r>- . a� ..,�.�,�w�.,t� „.,r�,�:�,,,.3 / � ,..,...,m „. <br /> Owner's Name 1 h ND l `.f 4) / Owner's Phone Number 9 / 1 z � /5 ( �%/e <br /> Owner's Address 6 zO C'(LL .[ I i/D <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholder Address <br /> MINE , EE emu -,.I .3s' ,L...: £ MNESZ ES I, •:: . `,_ AVAL - j : IMPA ” . - i EUMM€fikr' ° . ENTS".,�. w'MO a - ,:yo-;.. :"MPASE•k. P ,2. MEMTION - : i ..: EE <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> amourems oomt: ±. 'insa d ° y ' «:::' mviwi . lE ralo m a`•«yii, &-ewdY Via. • , . : "aa akragr mismia . s m.:y r in <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 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 /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IQtrlyl !Semi j Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm IT ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 / 1 1 1 Sprinkler System Installations <br /> Hood Suppression 2 ❑ ❑ ❑ 1 Nea) 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps Waste Tire Storage ANNUAL <br /> n Fire Works <br /> F-7 Flammable Application- ANNUAL 1 1 Valuation of Project <br /> n Fuel Tanks <br /> n Other: <br /> m mf:L: _rxs., : ;am M' iam.N. , x ' :"�"'::� '3: Ei?..,� ... .': �. . ^,.. s:. � .m:: c .A �.y,''.. u :Kka' : '12. Va .,. a e Rr, r,w , s,,.:« Eij <br /> Contractor Company <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address I I License # 1 <br /> ELECTRICIAN Company 1 <br /> Signature I Registered Y/ N 1 Fee Current I Y/ N <br /> Address I License # <br /> PLUMBER Company 1 <br /> Signature Registered Y/ N . 1 Fee Current Y / N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N j <br /> Address I I License # I I <br /> OTHER Company S' _ ., • 4 , r P L <br /> Signature � �C U2rry Registered Fee Current WWI <br /> Address 1 /8336 I/9/a,E8Wet ;6-D / !>� 0)7 /Z < SZ31 License# jUZSS c>0() ?ob <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 />