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813-780-0020 City of Zephyrhills Fire 0, I I)", <br /> Fax -813 780-0021 <br /> Permit Application <br /> Date Received Q1 O ' ,, <br /> � w. , 0 • r _ a tea , � . _ . �. .. <br /> contact for Permt � �� 9 y 2 19 ry 3 <br /> Owners Name I Z.e- 14rAr►i1k5 ' k €i C.a.1 A45 LL-C I Owner's Phone Number I 1 1 I I I <br /> Owners Address I IA I '6 (o CO‘plol 54 A¢, 1) r. <br /> Fee Simple Titleholder Name 1 ( Titleholder Phone Number I 1 I I l <br /> Fee Simple Titleholder Address <br /> m:,.h 4. ` .b. -. Mi u *t4V.*k∎. �' q?i'*t. atAa ..0 ..*VX f RP _.. s -..1'1 .. W— <br /> Job Address 3 3 a "5 Gr'GG►ti s to p C. - 1)r. Lot # <br /> Sub Division Parcel # 3 . 4 - 1 - 2 5 - 2 1 - 0 0 0 0 - 0 0 ' 3 0 0 - 0 0 l <br /> 0 Bio-Hazard Waste Storage - ANNUAL 0 Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> p Comm Exhaust Kitchen Hood/Duct ED Hood Installation <br /> Controlled Bum ED LP/Natural Gas - Installation <br /> ED Emergency Generator < 30 kw LP/Natural Gas - ANNUAL Sale <br /> El Emergency Generator > 30 kw Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL ED Recreational Bum <br /> ® l Other <br /> Sprinkler ❑ ❑ ❑ ( I El Sparklers <br /> Fire Alarm ❑ ❑ ❑ I I j Sprinkler System Installations <br /> Hood Cleaning ID ❑ ❑ ❑ 11 El Standpipes (Sprinkler Sys) <br /> Hood Suppression ❑ ❑ ❑ I I J Torch Roofing/Tar Kettle <br /> Fire Alarm Installation 2 k1,DJ Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor ,, I Company I A To-r�l 30 (� +Lu() I <br /> Signature ___ / , Registered Y / N , Fee Current I Y / N I <br /> Address 13 6 31 k e . 4 . t s - • Pd '1 r?on 5 v- S r 'FL I License # I ;c F / I <br /> ELECTRICIA Company I <br /> Signature j I Registered I Y/N I Fee Current I Y/N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature I I Registered I Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature I Registered I Y/N I Fee Current I Y/N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature I I Registered I Y/ N I Fee Current I Y/ N I <br /> Address 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 (httpJ /appraiser.pascogov.com) <br />