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813-780-0020 <br /> City of Zephyrhills "Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received 1 <br /> Phone Contact for Permit • <br /> .mac: � rot,.�,;� � ,,. <br /> �.: awr�ce.,x,w .. ua x�s'us� r«r,�a:«.�r..:..:�.�enu'... _ � & <br /> Owner's Name I ANDERSON PRESSURE CLEANING I Owner's Phone Number 181 -4 I 18R4 115 7f1R <br /> Owner's Address L 5104 MURRAY HILL DR, TAMPA, FT,, 33615 -4734 <br /> Fee Simple Titleholder Name <br /> I Titleholder Phone Number I 1 I <br /> Fee Simple Titleholder Address <br /> ai�' n. �I.,S3'$. � ati" .` "•��t;i� 'u�'"..F- /� -=�'u: ?ate. app°`^ '�a.'§+T+'f.'""F"�pR+`;xM'S -d: i. y " ° "�` e �'."'m#� 4 " €:e"'$'. "AM (W'�. .�7V� f�m � <br /> Job Address (GOLDEN CORRAL 6855 GALL BLVD. ,ZEPHYRHILLS.FL.33542 -2576 I Lot# I <br /> I I Parcel # I <br /> Sub Division ° <br /> n Bio -Hazard <br /> to Storage - ANNUAL Fumigation Tent <br /> WI Comm Exhaust Kitchen Hood /Duct I_n Hazardous Material (Tier II or RC Facility) ANNUAL <br /> El Controlled Bum I Hood Installation <br /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> in Emergency Generator> 30 kw <br /> n LP /Natural Gas - ANNUAL Sale -•- " <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly -ANN • <br /> ILttriy� �SemiI uT111 I Lther I <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum (�! <br /> Fire Alarm Ei ❑ ❑ ❑ I I n Sparklers r J <br /> Hood Cleaning ® 0---,4-12 I I n Sprinkler System I stallatio l <br /> Hood Suppression 0 ❑ 0 ❑ I I n Standpipes (Sprinkler <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works I <br /> Flammable Application- ANNUAL <br /> 1 Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> " .aY.?4szY <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current 1 Y/ N I <br /> Address 1 I License # I <br /> ELECTRICIAN Company I <br /> Signature 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 I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address 1 1 License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # a.. <br /> I <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 />