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<br /> 513 - 780-0020 City ofZephyrhills Fire t V Fax-813-780.0021 .
<br /> Permit Application c2 JQ / -
<br /> Date Received I � /� /O I Phone Contact for ermit 1 7/3 I Num j�.37_�
<br /> ,.. , y4 rit n�1�,/��.�J , � /o�.� --� -�/) q.
<br /> Owner's Name i �i� /-t 64 c %l� 0 - ? rJ / I Owner's Phone Number 1 7/,3 7. 3 Pala
<br /> Owner's Address ---3? 737 C /Wt 2 9/ 33
<br /> � 7 ? -
<br /> Fee Simple Titleholder Name Titleholder Phone Number d �3 7,P3 2Jo5
<br /> Fee Simple Titleholder Address I ,
<br /> .. .;i :...,,a MI..,.s' , SV ','IE.,,. SII ?„` 'NSIMNI)�,o " y;`i I., � dUM it fMEMISMA
<br /> .a:.,.,.' ,fi.xv. .;:x.,' , ..� ^., ., Myea,.,,, Air a r.,.,,. ,., a3,260A,T:nrai NCisF`r:
<br /> Job Address 3 723 7 d--. /QV L - !-. /°' ` 1 'IM / JYS 5' 2 Lot #
<br /> Sub Division Parcel # J 5- -2 -/- 00 JU '0 3 i60
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<br /> n Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> El Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> F - 7 Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> p I-1 Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL .04fieou
<br /> l (ttrly) 1 Semi I (A Uther
<br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum ,
<br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ ( I n Sprinkler System Installations 1 11. 1 V
<br /> F ood Supp n ❑ 1: El I I n Standpipes (Sprinkler Sys)
<br /> ire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL I Z. 63570 0 ' I Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I I
<br /> nnammta • 4 1 - A aa�.�'. 4,m: ”" atmem : ot4O5 :. 3 N .« § #Sid".° E:rNft , e..,.:a i., ...:,a ..; ..... - , -t.. - •s it u::.w, .. ,. Zga�
<br /> Contractor Company It•-� &o/l./ S 1 12 _
<br /> Signature - J fl Registered DM. Fee Current Y /
<br /> Address i 4.7 !/L A '/V /' TiQfr7? .. .F _,/ ! , 3y License # I C ?,
<br /> F 06 O 3M. ' 1
<br /> ELECTRICIAN / Company I
<br /> Signature Registered Y/ N Fee Current I Y/ N j
<br /> Address I I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<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 (http: / /appraiser.pascogov.com)
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