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V44- 30 f Z <br /> 813 - 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received J Phone Contact for Permit 3 1. o • <br /> Owner's Name I ' RL b I l 1.�.' C <br /> SG r / 'J -4 C. + Owner's Phone Number Ig4O J ` I 079 I I S-7001 Owner's Address (!"T'�'1Y1 _ - e iL*- L t C eASt 1 �i w C.h u.rCk ► f lct (l.' V 1 l t-e 3 7 t) <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Q om ,... � : <<„ <br /> Job Address -1 -! 09 c 11 ( U a 2-eph h %1 Is FL *35 2 Lot # <br /> Is ', <br /> FL. <br /> Division Parcel # Z S I-'oc Lo --o loo `QOOO <br /> I — I B io- Hazard Waste Storage - ANNUAL Ii Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I] Controlled Burn Li Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw P /Natural Gas - ANNUAL Sale <br /> I1 F ire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> try (Semis ma Other <br /> Sprinkler I ❑ ❑ ❑ n Recreational Burn <br /> Fire Alarm 0 ❑ ❑ ❑ I I I7 Sparklers <br /> Hood Cleaning I] ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I] Standpipes (Sprinkler Sys) <br /> r F ire Alarm Installation r---] Torch Roofing/Tar Kettle <br /> I] Fire Pumps I7 Waste Tire Storage ANNUAL <br /> E Fire Works <br /> 0 Flammable Application- ANNUAL ( ( Valuation of Project <br /> Fuel Tanks <br /> I] Other: I <br /> .a.. , vim_, ? 1 * :.,.i m .4.4 .. 'KO P ,.,,, ,....,.; ; ; ;• : . . <br /> . } "' ,:x ....4.. . ' > man;`, 4- N :.. . ......R., <br /> Contractor / •,''L,' �//i'jJ/ // N/A Y / A � C III Registered Signature , � . �� t / / //J Registered Y / N I Fee Current l Y/ N I <br /> • <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I License # <br /> Directions: 1. <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 /> \ I W 1 oCih i p+ <br /> 5 `- -)-- r-e-e + <br /> Z - P r a h \ rh 1 1 t s P <br /> . -Sy 2 <br />