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813- 780 -0020 City of Zephyrhills Fax- 813-780 -0021 .
<br /> Permit Application
<br /> Date Received Wain W A •I - Phone Contact for Permit
<br /> ;. 1 u... .,w..a.r.,...
<br /> Owners Name (� t? y f j. , I l ,5 C i u -eM /0 I Owner's Phone Number .c 6 / 716 / .2 d o
<br /> Owner VW s Address Li ! 6 6 R. 1 1 e I vat - a'e e R' ((' t, 11 / P. 3-541 9-
<br /> Fee Simple Titleholder Name / Titleholder Phone Number
<br /> Fee Simple - Titleholder Address I
<br /> ,ti �. , wm,MT x ?,. MP 6r ° " ' ,:r„ .,- -1,,i, `. u.. - -: - .. f1 .. -- ,, ,4- :,-, %h :t .., .. _: „ ,6a., , �” La . mamo ".. szty
<br /> Job Address £ 6 L p l °� c/ / J r 8 1 is - Z e k r yJ 1 // < F •- 335v_ Lot #
<br /> Sub Division Parcel #
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<br /> El Bio -Hazard Waste Storage - ANNUAL Fumigation Tent
<br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I Controlled Bum Hood Installation
<br /> I I Emergency Generator < 30 kw LP/Natural Gas - Installation
<br /> ~
<br /> I I Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale '
<br /> Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
<br /> IUtrlyI Isamu T� Fi mu. // f1 /�,
<br /> Sprinkler I l ❑ ❑ 1' ( Recreational Bum / i
<br /> L%
<br /> Fire Alarm I ❑ ID ❑ I Sparklers c
<br /> Hood Cleaning I ❑ ❑ ❑ I I Sprinkler System Installation
<br /> Hood Suppression I I Cl ❑ ❑ 1 I Standpipes (Sprinkler Sys) ,�
<br /> El Fire Alarm Installation I I Torch Roofing/Tar Kettle
<br /> r---1 Fire Pumps I Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> Flammable Application- ANNUAL I ' Valuation of Project
<br /> I Fuel Tanks
<br /> III Other: _
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<br /> 1. ?,�z�y Z . �t, ...
<br /> Contractor �( • ,� • Company i- F re f!' (r vt's.
<br /> Calk
<br /> Signature v v _ Registered Y / N I Fee Current I Y / N
<br /> Add ess ; S0 - 6 cc. A) n141_4P 4S4 • -rp4 FL. 1 License# I 111. a- 73ooei=007
<br /> ELECTRIC • N Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current 1 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 ElWI ; , � �y'
<br /> Signatur l 00 A 'V J Registered Y / N Fee Current Y / N
<br /> Add ress ', 0 c9 /J 5 • - 1 f!.' `'
<br /> License # ; g ; ,, 410 0 •00
<br /> Direction IIII,
<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)
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