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313-780-'0020 City of.Zephyrhills Fire. 1 ! o( f Fax- 813- 780 -0021 Permit Application /' Date Received I �R )O J O /0 Phone Contact for Permit g/3 ...5 q3S'1 / p >..�. / 3 9..fN_....e.,....,: �..,.a:a:�_.,r..:r.....�_. Owner's Name L�2L 97 32 �,/ Owner's Phone Number d 544,5- , 3.57 Owner's Address r 0. O % / 32 4MPI' 1 FL 33 679 Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address I Y. .x'.00- y ? :. a.&:#, .,7- t ". v . / + .- .,,, :.YS.. ; ., , ..' a,: - -`�a, -Is ,,,,, `,n.4 '.. z;.. -.- , "..- ;. z wG ,- Fw . as a, ., 2 : . «. .6±X-Zs.„.. s .„ - eta ; it Job Address C1 /AM le 0X- `j2 4 &f}'1 -1- 23144 . Lot# Sub Division Parcel # .nth.+'ak'�i- cn1'E:'atsx.✓;a^ ,4- 4%S^., +aa- .*e+21 a+R, e` ..e„ _,. .. .. _ w. , .. -. ar°.»iTa: -N ..5. ,. -.r>P wv *>s, .; ._. 4:r_ .^. P 'a '.a'iFi�(aPS+KiRw. f`.e -..? *«cs n" „ Lea .'dwr ,�,. Bio-Hazard Waste Storage - ANNUAL I I Fumigation Tent Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL Controlled Bum n Hood Installation Emergency Generator < 30 kw • I LP /Natural Gas - Installation Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL I Uttrly1 'berm I !Aril I Other Sprinkler n ❑ ❑ ❑ I I Recreational Bum Fire Alarm I ❑ ❑ ❑ I I I Sparklers Hood Cleaning I a ❑ ❑ I I I Sprinkler System Installations Hood Suppression I] ❑ ❑ ❑ I I 1 Standpipes (Sprinkler Sys) n Fire Alarm Installation I Torch Roofing/Tar Kettle I Fire Pumps I Waste Tire Storage ANNUAL Fire Works Flammable Application- ANNUAL I ) Valuation of Project I Fuel Tanks Other: I I Contractor Company ti/Vi 1�-& S?,I!/ /GAS I Signature Registered Y / N I Fee Current I Y/ N - I Address I I License # I ELECTRICIAN Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I PLUMBER Company I Signature Registered Y / N I Fee Current I Y / N I Address I I License # I MECHANICAL Company I Signature Registered Y / N I Fee Current I Y / N Address I I License # I I OTHER Company Signature Registered Y / N I Fee Current I Y/ N I Address License # Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)