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R13 -780 -0020 City of.Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received 1 Phone Contact for Permit <br /> ` <br /> Owner's Name - u .r1nivvili � ��i 0e /4ur-e oc> Owner's Phone Number � '/ 3 7.P-2 3 /ZS/ <br /> Owner's Address , S / s - -1- S /1-e c 7 Z.7`7rA //.5 " <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> ... .,. •. MSMW Cane - f a"+n' . aW ala Mg V,Arz .�; z ?'x t&d . � igkU � "".w .Se MZIO . a� a :r:,i hf.:,< m"EU ffiia:,. ,4�ua;a gfarall U, . .r:.: �....ntraf a:, <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I—I Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I - 1 Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IC.ttrly1 1Sem) WU Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> n Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression Fri ❑ ;Sl ❑ I 1 [] Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> Ti Fire Works <br /> n Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> Q Other: I <br /> €....nu'mmi"azs z.. 5..mata,. :; n , a ,V; s4.4*. ',..* ?._= : datAVMEEEABfal '' ., tgir ;RS5;,�"'."�.w., .. gMenSV a..,.A .f..a meal :..s:m::aga;Wa <br /> Contractor Company I <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y / N I Fee Current I Y / N I <br /> Address I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N . 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N 1 Fee Current I Y/ N I <br /> Address I 1 License # I I <br /> OTHER Company - LP. 79 Lis - tly�i > ^ G L-e.._ <br /> Signature -_ Registered MIMI Fee Current oirliAla <br /> Address 4-330 d,, , a r; 7" ,cZ 3 5:2 4, License # r►60SBC129 <br /> q arkare.u'&?»:' s .r_.«;. . a ,,,,,,,. «a_., .,.,: ...16b az=.m,..::..dra s %<a < ' --a ; 1 a a ,. '4t « r,ma«.18,.1 a. ..•. .si. ..,.flW.. ,,,<.x.3. s, ; rraaUtaffigNanra <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 />