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813 -780 -0020 City of.Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I Phone Contact for Permit 1 I 07(--, I <br /> Owner's Name 9 ! G2 ( I <br /> cr r (7JS Owner's Phone Number 13 7i� 1 6 ? 0 <br /> Owner's Address 6 / ,01: d ( )4 hhoi �l D H `Q Or �� // /(�' / <br /> Fee Simple Titleholder Name - I Titlehold / err Phone Number I 1 1 1 1 <br /> Fee Simple Titleholder Address <br /> Job Address e`' 6 2- ( 4697 . c;‘ / en L <br /> Lot # <br /> Sub Division Parcel # I I <br /> El as t r.€ix,s> >.r,,,, <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I I 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 /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> IQtriyl ISemil Gil Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum ?C75.--- <br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers (° <br /> Hood Cleaning n ❑ ❑ ❑ I <br /> n Sprinkler System Installati• • <br /> Hood Suppression I ❑ all 1 n <br /> ' 1 Standpipes (Sprinkler Sys) <br /> n F ire Alarm Installation n Torch Roofing/Tar Kettle <br /> n F ire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n F lammable Application- ANNUAL I (S'7 ' Valuation of Project <br /> F Fuel Tanks <br /> F Other I <br /> ,�..G. qa .EGE.. >M<e..a'.... :r. a:k ^•;r e':a 4:: _` ��:�a'��.. F.:xe.,7°s:z, =a ,.:a ,•= I <br /> Contractor 7 lA <br /> Signature �'��' Company i <br /> _ Registered Y / N I Fee Current I Y / N j <br /> Address I 'o oar pj - L, N 1 o'Z 3y63y I License # I <br /> ELECTRICIAN Company <br /> Signature I <br /> Registered Y/ N ] Fee Current I Y/ N j <br /> Address I <br /> License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N . 1 Fee Current I Y/ N j <br /> Address I License # <br /> Directions: <br /> s e <br /> Di „ :tea - <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 />