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813-780-0020 City of.Zephyrhills Fire. – /1 Of co Fax-813-780-0021 �p f / / P Date Received 1 4AR. ) t/ o tact for ,g / 3 5 S c-135-1 w w Phone Con r Perm Owner's Name L S,2��i 1740g1/74647/ �t1 Owner's Phone Number Si 3 55'5 . 9 3 5/ V. b Owner's Address ? O / . 9738 T , 4/ L IM1 r `� 336 7y Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address Job Address GOLD A/ P4-A/DA 37,115- 7 / l 5 e1 L &vp' Lot# • Sub Division Parcel # Bio-Hazard Waste Storage – ANNUAL I Fumigation Tent I I Comm Exhaust Kitchen Hood /Duct I—) Hazardous Material (Tier II or RQ Facility) ANNUAL I Controlled Bum I Hood Installation I Emergency Generator < 30 kw - I LP /Natural Gas - Installation I I Emergency Generator> 30 kw 1 I LP /Natural Gas - ANNUAL Sale I I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL I uttriy I I Semi l rA"nTI Other Sprinkler ❑ ❑ ❑ 1 I Recreational Bum Fire Alarm E ❑ ❑ ❑ I I [ 1 Sparklers Hood Cleaning 7 LI ❑ ❑ ( I I Sprinkler System Installations Hood Suppression I1 ❑ ❑ ❑ ( I I I Standpipes (Sprinkler Sys) I I Fire Alarm Installation I i Torch Roofing/Tar Kettle I Fire Pumps I Waste Tire Storage ANNUAL I Fire Works I I Flammable Application- ANNUAL 1 ( Valuation of Project 71 Fuel Tanks fl Other: I ,,,,. = ;ya,r - "na - . a?;.te. sa« .. •:_.s „,.M �': ., .y. .:_. -�„ .., -. .. ,c,r.- m -.. .. ._.._,... �r__,...c-.,., ._.,,. ... _. _. - _ i Contractor Company UIVIVeEPSE SEQV/CE C I Signature Registered Y / N I Fee Current I Y / N Address I I License # ELECTRICIAN Company I Signature Registered Y/ N Fee Current L Y / N Address I I License # PLUMBER Company I Signature Registered Y / N Fee Current I Y / N I Address I I License # ( I MECHANICAL Company I Signature Registered Y / N I Fee Current I Y / N I Address I I License # I OTHER Company I Signature Registered Y / N Fee Current I Y / N 1 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)