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813 -780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> • <br /> Permit Application <br /> Date Received 1 201 i © I Phone Contact for Permit I /c 11CS q <br /> Owner's Name (moo (d.-c ✓\ P0.vx 6.0-- Owner's Phone Number l Sd 1 3 I I ? 79 I I 1 s $ ( 1 <br /> Owner's Address . i c 1 i e2y-, Y\ A_ 6 1 v a 2s k ft-6\k 33 SM Z <br /> Fee Simple Titleholder Name Titleholder Phone Number I l <br /> Fee Simple Titleholder Address <br /> fix: € i iiiiibmg <br /> Job Address PI Lot # � � <br /> Sub Division Parcel # <br /> '.." ike aw A.100 ,''�,� ,;rim « Wk. VAa#.4,l€a,:a:•ii,.:4W <br /> Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I I Hood Installation <br /> I --- ] Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw I , LP /Natural Gas - ANNUAL Sale <br /> j � i N Fire Protection Maintenance - ANNUAL FT Places of Assembly- ANNUAL <br /> IUtrty1 'SemiI (M Other <br /> Sprinkler ❑ ❑ ❑ I 1 Recreational Burn <br /> Fire Alarm 7 ❑ ❑ ❑ I I El Sparklers <br /> Hood Cleaning TI ❑ ❑ ID I n Sprinkler System Installations <br /> Hood Suppression 0 ID ffi / ❑ I I I I Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation El Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I 3 V © CO I Valuation of Project <br /> IT Fuel Tanks <br /> n Other: I <br /> Contractor - <br /> Company <br /> F,; r s� t..��i Inc <br /> Signature --- ___.__ C . � I <br /> r"— Registered N I Fe Current / I Y / N <br /> Address I Qp C, s 8c j `_„,,,,d, Q LA. 5 3y 6 39 , License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y / N j Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature <br /> Registered Y / N j Fee Current I Y / N <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y / N J Fee Current I Y / N J <br /> Address <br /> .1... �' ' cSr.� .�,n »ia�w�.d'ziG..iia.•* E € <br /> ce se# <br /> •iY#. <br /> Di rections: _.���..:_� ...,::_ _.. __:. .......: ..�....�: .. 1.. _4.: <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 />