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'4N /19/2009/MON 08:42 AM ZEPHYRHILLS BUILDING FAX No. 813 P. 001 . <br /> 813 -780-0020 City of.zephyrhills`FJ e J V" C <br /> • <br /> . Permit App!I atIo Pax-813-780-0021 bate Received . <br /> a :nrraa�.. <br /> Phone Contact for Permit - • <br /> Cwner'a Name I [.l y" 22oh t?n 1�, ii,.. j <br /> n Owner Phone Number $� > FEET/ <br /> Owner's Address 1 -361/ <br /> .1 /V, • ∎*Pkt ech. ! L< F/ r: 3 3 $'z . • — <br /> Fee Simple Titleholder Name I ' <br /> 'Titleholder phone Number I <br /> Fee Simple Titleholder Adgreas <br /> Job Address .1 Ca MIie 2,1 rh! / i_53. 1 33.�"y Let it ' <br /> Sub Division <br /> Panel # <br /> . 1 ^ 1 Blo- Hazard Weete Storage ANNUAL pi <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct CI Hazardous Material (Tier 11 or RQ Facility) ANNUAL • I I Controlled Bum • El Flood Installation • <br /> n Emergency Generator c 30 kw 1 l' LP /Natural Gas - Installation <br /> ' .p7 Emergency Generator> 30 kw LP /Natural Gea- ANNUAL Sate <br /> n Fire Protection Maintenance - ANNUAL <br /> n Places of Assembly ANNUAL <br /> • <br /> Sprinkler t--� ❑ p ❑ Recreatlorial8um <br /> • <br /> Firs Alarm ' + 0 —"�1 <br /> f.- ❑ J I Sparklers • <br /> • <br /> Hood Cleaning ❑ <br /> Sprinkler System Installations • <br /> Hood Suppression I I 1 1 0 O I I E . <br /> • j Standpipes (Sprinkler Sys) • P 1 J Fire Alann Installation I 1 Torch Roofing/TarKeltle <br /> Ftre Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flamntable.Appilcatlon•ANNtiAL , ' ' <br /> 0 : Fuel Tanks I�� Valuation of Protect <br /> 0 Oter: , , <br /> Contractor <br /> signature ����W = :� � ; Company �r Tr-rat StJ`l r "'f�'4 <br /> ��- �� Registered Y / N � Fee Current Y / N <br /> Address }��i� I L r �+ <br /> 1.Sj� License # : . 1 Gf� /aJb I <br /> ELECTRICIAN! .... <br /> Signature I (' Company <br /> 1 Registered Y/ N J Fee Current I 'Y / N I • <br /> Address r <br /> PLUMBER License # <br /> Signature I 1 Company I <br /> J Registered Y / N ) Fee Cuneni ( Y / N <br /> Address I . <br /> MECHANICAL) License # • <br /> Signature I Company <br /> • <br /> Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address ( . • <br /> OTHER License # . <br /> Signature I Company <br /> Reglatared I Y/ N 1 Fee Current I Y/ N 1 <br /> Address <br /> freedoms: License # <br /> Fill out application completely. <br /> Owner & Contractor sign back of application,. notarized (Or, copy of signed contract with owner) <br /> If over 52500, a Notice of Commencement is required.(Meohanlcel work over 35000) <br /> ' Supply two (2) sets of drawings with applicable documentation <br /> Allow 10 -14 day. for review after submittal date. Farce; # - obtained from Property Tex Notice (http: / /epprelser.pascogov.com) <br /> • <br /> • <br /> • <br />