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813 -780 -0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received I Phone Contact for Permit j I <br /> Owner's Name I /4 . i 3 1 /,1% , /A1C., Owner's Phone Number I / 1 7/5 CPS Z cl <br /> Owner's Address lo' A /4.c7<r ■91/E 274i- h /A,‘ <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple - Titleholder Address I I <br /> yi..s?7' -2aE ` - ;*"`s&�';::.•;�"= "i ;a" ° <. a:. ;. "a fi,&.* +*;'.;';o-8 . ` ":uz'- -�kc�. .M.c.,::: saY ...�.: .0.1'.?. <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> yam : '.. aarsa s &As , .-- ,....1 . ,,- <br /> .. ,,. m < - . r. -.- + 1 ar ,s F: ;4 akt W , iii< <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II 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 /> I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> I Qtriy l (Semi l fART1 Other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning ❑ g ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression {J ❑ g ❑ I 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation Ti Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> ri Fire Works <br /> FT Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> In Other: I I <br /> Contractor Company I <br /> Signature Registered Y / N j Fee Current I Y / N <br /> Address I I License # I I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N J Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I 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 # ( I <br /> OTHER __ Company .Selz- vrlj�-rec� �p��„0" -r 7 LL,c I <br /> S - _>y•. Registered 6J N 1 Fee Current 1 N <br /> Address 1 AP i,a,,,', - f Z/ t c � A2 33SZ G I License # �jlv s - >y /?y0, <br /> x�urn..x' . ., ..�,:;: .y.. - •,r , >,`., ..�..u;+a;� ., ,... .�_ .._ auaa; Hw., isa +x,„u,,,.axa,�:.�:_,'a:;•x''�: <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 />