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• gu,e�% PAR a / ��. <br /> 813aso 0020 City of.Zephyrhills Fire / Fax•- 813- 750 -0021 <br /> $ ii I o Permit Application <br /> Date Received Phone Contact for Permit 9i <br /> Owner's Name 04 V E gp cm A ,-C,.4PF Ql`}P Owner's Phone Number - f / '3 7 S1 / , 2 s 8 <br /> Owner's Address 3 9 7.35 e_>9 nAlee g laX}-] <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> . q .. :.wt+rY.r.MSC'rc:�?�t , r.;. ».'ax e w 4k= .. -r�:. r r-,,,,,,s:.r.. < _ ,. ,,.._ ::;:E`.,..t .ti;,;r t _^� xs h «'i> &'§ #•'_...,. C'aidm. da" ...., a'"... <br /> Job Address 99 73 5 - OMN O 9J' Z- N /LLS' 335 `/a..... <br /> Lot # <br /> Sub Division Parcel # <br /> 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 /> al Controlled Bum n Hood Installation <br /> FT Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL • n Places of Assembly- ANNUAL <br /> ILttrlyl 'berm' UM tither <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I ( n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ l I n Sprinkler System Installations <br /> Hood Suppression Ei ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> H Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works <br /> n lammable Application- ANNUAL I /V V. 00 I Valuation of Project <br /> n 1/uel Tanks <br /> P1 Other: I <br /> r <br /> Contractor v <br /> Company - (61 6 - Signature .. I - , � Registered Y / N I Fee Current I Y / N I <br /> Address NOP' <br /> �� I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address 1 I License* I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address <br /> License # <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 />