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5 / t✓. City of Zephyrhills Fire Fax- 813-780 -0021 <br /> r‘,/ I ` , Permit Application <br /> ( Phone Contact for Permit 11a, 6—'5/ � j ?3.3 <br /> Date Received <br /> Owner's Name 1 t e Y 'C 1 A A {c Vol �� Owner's Phone Number <br /> Owner's Address 01: `k) 0 CA OW e c t 4:F 10 l J Or iawU3 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address ) GC. l, ci l v CJl ��-- Lot # <br /> Sub Division Parcel # 34 -- .)`" - d 1 - €X J 't_, - 00 - (X> <br /> . , = e . :::. ,zCAU ah 1a...ka ,. »ss:: x, ': w z bravo .i -w?: ; azt= s..wa' a +:" a Rk?,irsz am?' fri lu k. r _owtztvoN:v,:V�;Sr�;..., c.w <br /> I I Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I I Hood Installation <br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> [eitil7 Semi) f r " "' 1 lJther r' <br /> Sprinkler n .0° ❑ ❑ n Recreational Bum f <br /> Fire Alarm ❑ ❑ ❑ ( I I Sparklers 0 <br /> Hood Cleaning n ❑ ❑ ❑ I 1 1 I Sprinkler System Installation 4( f i <br /> Hood Suppression 0 ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps ( I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> Fuel Tanks <br /> n Other: <br /> ... : : :. at_.e.i;:.''1,70WRIM... Spa': 4fi .WrI:; sr...WA2:a iliME dE: .':_". , ATI4i AVZOA`:,.`:.., .' AMMIIM'4" ..:'' IIMEMM !» WIMITT MAIM . ejtjf".�` NRWIffi'cl: <br /> Contractor Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address I I License # ( I <br /> PLUMBER Company I <br /> Signature Registered Y/ N j Fee Current I Y / N <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N, <br /> Address I I License # <br /> OTHER PICS-kljj2- Company A . � '� F Qr * � A ; `' ► O 11 <br /> Signature l Registered yam Fee Current Y / N <br /> Address 5 a l (c) m YYv , r ue_ I License # I 1 - g La OW t <br /> � 94C- <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 /> S' 0 J <br />