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7 b , <br /> 813 - 780 -0020 City of Zephyrhills "Fire � ) 1 3' ;�- � X-813-780-0021 trqq 2/1 <br /> Permit Application ► O sv N& <br /> • <br /> Date Received _ ., 0 . �._ <br /> P Cwrtactfor Permit L' lf� i•S��/11 'I <br /> Owner's Name I 46/7y OF ,..c1' L*ie/i /X -S I Owner's Phone Number l 1 1 1 <br /> Owners Address ` <br /> Fee Simple Titleholder Name Titleholder Titleholder Phone Number I ( 1 1 <br /> l <br /> Fee Simple Titleholder Address <br /> Lot # <br /> ! & <br /> °��., -: � v*� ° .°sue . ,e � sa'mfsfi a :',''"� ... _.,. � o-. .. •.. >rkxa t. � ,r .��.� v.?. o sz;. ,.. .,s , _., �w .. , - .. 'S:a` ..M , <br /> ._...,..d.,,,. .'�'S" =. ,( � . ,`� ..H�: Yn�e;t°;x ems. <. „ i:� : <br /> Job Address . 1 �< y d) 1 V � � cti ZP°l �� r G, • I l ` <br /> 1 J I Parcel # 1 <br /> Sub Division , . .. _ <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> 0 Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum 0 Hood Installation <br /> n Emergency Generator < 30 kw n tura <br /> LP/NaI Gas - installation <br /> n Emergency Generator> 30 kw 1 LP/Natural Gas - ANNUAL Sal: <br /> n Are Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> z ,bens) ] puler <br /> Sprinkler ED ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm 0 ❑ ❑ ❑ I ( i I S pa re <br /> Hood Cleaning in ❑ ❑ ❑ I I Eg'S System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> M Fire Pumps n Waste lire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ez2y 7 .15D I Valuation of Project <br /> Fuel Tanks <br /> IN Other: <br /> . ' :8ta: ,.!s :..r •ew. z, ,.�iu ;sr « �±+ a.. : ;.n...,.a_.,<:;.44..K A� ..n- ;�hx¢, awm -r-- ..�.,e. - .-...r K..'... • w • _�':`° .,.* a sac' - u.;x c?..i.s,.a. ; :n v,x .,wr 'u �t- &:c . >%c? ,,. b�••5:n.'„ r. <br /> Contractor ,, ,4 , Company ,. A F r€. - CinOAss 125-2 <br /> Signature C, VV Registered *AM Fee Current Ilro__ <br /> Add = ss ; 5 0 s - 6 t t. 0 ril'Fs:24 P u -f • — rp . 7L. 1 License # i 4 10 4 9-7 3 a a o 1 o o7I <br /> ELECTRIC • Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N i <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address 1 I License # <br /> OTHER • Company ��T•a��; ; • AJ vt <br /> Signatu : Registered Y / N Fee Current Y / N ilA <br /> Ad ress wG pY /� �Etju .r..s&I /i License # $' a I • • •7Q0 <br /> Direction " <br /> All 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 />