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813 - 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> - <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> / ; <br /> Owner's Name I W 15 T L broo �` . M k /tor I Owner's Phone Number Ig(3 I Z) I VY/ 7 <br /> Owner's Address ' 7O/ P i f 2,/717x-A,//5 4 as I / 2 , fi 33Sy Z <br /> Fee Simple Titleholder Name I ! Titleholder Phone Number I I I <br /> Fee Simple Titleholder Address I I <br /> Job Address 5 I I " <br /> Lot # <br /> Sub Division Parcel # I <br /> „',�?"t -,.., sa+ c�. eaMPs.... �r;. s, w- .nirra:I.`�.:e;;7#kr«?7«t�5, r.[r` „sa.vsr .. n»,- mro :':_awPo.- . "%n.9.'Cvan...rr.!E .:.NS ja �t u`" a?. r. u anr'!..:'” C.,. fr' x2Ru9 •*a'=3?t&3^sw..�,.ti= `?*.§t�, w# <br /> 0 Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n C omm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n C ontrolled Burn n Hood Installation <br /> In Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I E mergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> (Qtrlyj (Semi) Other <br /> Sprinkler IS El ❑ n Recreational Burn <br /> Fire Alarm No ❑ ❑ I I n Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ 1 I n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> n F - ire Alarm Installation jj Torch Roofing/Tar Kettle <br /> n F ire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> 0 Flammable Application - ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> 7 O ther: I <br /> - ;� , = k ., .z. ,,,,,. , •.,.. h .,r .,, n,, �...�..�,es �. . _.:�.., . emu. �n,,�,.etM mr t . s <br /> Contractor . l�� Company r i /c4 F <br /> /�O M I O <br /> Signature / Registered Y / N Fee Current Y / N <br /> Address 179/a Pio 6/ /RC-l , ,f:Q / FG 324-317 License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 <br /> I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 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 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />