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81378070020 City of.Zephyrhills ( 106(7 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received (4 n 6 J© - Ph _ .__ - .. <br /> Phone Contact for Permit A <br /> �/� �/ �i 7gcal . L/3 <br /> Owner's Name �t 7L ,1-- F [ n ( t �v C C finer s Phone Number <br /> • <br /> Owner's Address 5 5C ) (4-h ec ` 2Q hL h 1 1 1 ` <br /> `� - -`3LI 1 <br /> Fee Simple Titleholder Name I U I Titleholder Phone Number ( I , <br /> Fee Simple Titleholder Address y �, <br /> Job Address 5 560 (0:-'s- 7'QJph L( ■ I 1 35(-1i Lot# <br /> "J <br /> Sub Division Parcel # <br /> I Bio- Hazard Waste Storage — ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I I Controlled Bum n Hood Installation <br /> F - 7 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 1 Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I Places of Assembly - ANNUAL <br /> It-ttrlyl 'semi 1 Fa 1 other <br /> Sprinkler n ❑ ❑ ❑ ( Recreational Bum <br /> Fire Alarm n ❑ ❑ I . ( I l Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ ( Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ ( Standpipes (Sprinkler Sys) <br /> ( I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> 0 Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> Fuel Tanks <br /> Othe <br /> la <br /> Contractor ll 1 Company �" 00 F�'1 S ._7 i1 ti 1 IS F 1 5'>-J P <br /> Signature .A L a I• Registered Y / N I Fee Current ' V/ N <br /> Address I ( License # I <br /> ELECTRICIAN Company ( <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company 1 <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address I ( License # ( ( <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered _ Y / N I Fee Current 1 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 wtth 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 />