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813 -780 -0020 City of.Zephyrhills Fire Fax- 813 -780 -0021 <br /> 'Permit Application <br /> Date Received <br /> Phone Contact for Permit <br /> Owner's Name f • �' l ; Z. a 6e.41,s C - Pi 5CC X 61 L Owner's Phone Number I S I I 2i : <br /> Owner's Address 11, S $ ss /6 it 5 tr -e- - -1 <br /> Fee Simple Titleholder Name Titleholder Phone Number I <br /> Fee SimpleTitleholderAddress <br /> Job Addre ss �.,� ...�.. <br /> I/ 5 D 55 ( .f L, --frrce-t- Lot # <br /> Sub Division Parcel # <br /> El Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent M <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum = Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator 30 kw - LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> rLr !Semi' FiT� Other <br /> Sprinkler i ❑ ❑ ❑ . Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression D ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> n Flammable Application- ANNUAL I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> IISSMISMINAMMIMMENDEMEMer <br /> . -.1v _,, a �- �. . •:,:E , <br /> Contractor / / Company (/ . <br /> Signature i .; -. ■ ■ ) L S.44f� 1 4.. ` , Registered Y / N I Fee Current I Y / N ^ j <br /> Address I <br /> I License # I <br /> ELECTRICIAN <br /> Company <br /> Signature I Registered Y / N J Fee Current 1 Y / N I <br /> Address I License #. <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I ' License # <br /> MECHANICAL Company <br /> Signature Registered Y / N j Fee Current I Y / N J <br /> Address I <br /> I License # <br /> OTHER <br /> Company <br /> Signature Registered Y / N . 1 Fee Current 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 (http: / /appraiser.pascogov.com) <br /> • <br />