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813L 780 -0020 City of.Zephyrhills Fire Fax-813-780-0021 <br /> - Permit Application <br /> Datd Receive8 L_ Phone Contact for Permit <br /> Owners Name 30/ 4' AJE•e c e-4. Owners Phone Number 1 q 1 36. 176 <br /> 9y <br /> Owners Address QZ'`J l -7n'-e& 73 L vb 2 1 /4 ,'Q- <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple'Titleholder Address I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> <� #q: a �. +a Y..r;�ke. ?L<w'.- ..ad ?d.,.e ... .✓..r - .c d'ie ., d-,. Re,54 - : _ "'� is^ tl .s ?k r i ,..... tS a i. .s t`,..2_ �' -� �, .F n .N?— �4i"m�4Yn', x.r «`-i 95- n<„1Y -.:C „�.i.o �35.%t ^`,'.`. <br /> = Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 1CltrlyI 'berm' j Other <br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I n Sprinkler System Installations <br /> Hood Suppression ❑ y ❑ I I n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> E Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> Q Other: I <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I License # I I <br /> ELECTRICIAN Company <br /> Signature I Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I ' License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # I <br /> OTHER Company v/v' .�i.€ ��t s�P/#794/1 Z -6. L' <br /> g =�� Registered Re ( N I Fee Current 1 CD N I y <br /> Signature � s• 9 <br /> Address ��— License # L;y • <br /> Directions: <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 /> • <br />