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813-780-0240 City of Zephyrhills "Fire ✓' Fax- 813 -780 -0021 <br /> Permit Application _ . <br /> Date Received Phone Contact for Permit 1 727 I-157-7 1-1-71;r- <br /> -- <br /> `gi �...�.. <br /> Owner's Name n, -,'/� ( p € / (£-C s , 1 / N' ' Owner's Phone Number 1 Zi 20 - 7 Z( t'& <br /> Owner's Address ,�o 6o X /DS t\J P ° , Ft, 34405e, <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> / < , r ..� ,..:r...r ,,. / ..�r;.; . ;k . ;:r ., .�.; <br /> Job Address J & 3 ( l 7 �'� gLV b z et y —t L / FL _ 33 Sob Lot # <br /> Sub Division Parcel # <br /> ,r... .}M`-r ?3_e, -fir t':Sv ?, 8.7s.� <: ...,Sn _'em .t 9"§.0 .{ „>Fa'ti::6 wF�-';3R,5>, i°4^ a �'. )!.a t:*Yaa ;o ,; xA+.:#,.. •, ?'`:°o-F� .&x•.?'s =W# - 9=_RVaa'€ >. =u�.. >s. -£8 "+° <br /> I—I Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> FT Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> man' i Semi i (al Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste lire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 1 Valuation of Project <br /> Fuel Tanks <br /> n Other: I ( <br /> ,kat f- s- 's ..� «,� >, ,, +iti, s. , .,»o x- `.�. , ".:k: .; •,a.... '� -: •. __. -.,. . -...o- s _ _ . �y m.. ......_;d � - :;Y3+ ,. r'?in. ��.n ✓�. n�kih.'e' <br /> Contractor Company I <br /> Signature • Registered Y / N I Fee Current ( Y / N j <br /> Address I 1 License # ( I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # I I <br /> • <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N j <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N J <br /> Address License # <br /> • <br /> OTHER / / Company NM- . C.C$, /W • I <br /> Signature Registered P N I Fee Current 1 Y / N I <br /> Address inrr. .1 r :or, N " License # • <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 />