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813 -780 -0020 City of Zephyrhills'Fim 1 Fax -813- 780 -0021 <br /> - <br /> Permit Application <br /> )ate Received Phone Contact for Permit 1 <br /> )wners Name I i- •t lzs± (' �ni` . C_ v, Gt r. rc z l Owner's Phone Number 1 Z/ 3 I) /7Xe). I 170-777 <br /> )wners Address 11Q 0 J $irt., St Z ee 1,,` t 1. 1 / S i c / 33 5 a-_. , <br /> :ee Simple Titleholder Name 1 I Titleholder Phone Number ( I <br /> :es Simple Titleholder Address I <br /> Job Address — I Lot # <br /> Sub Division IINIMIEIIgBNINIMIIIIII Parcel # 6 a • - , .1 - Ot) JO - oo r <br /> n rd Waste Storage - ANNUAL Fumigation Tent <br /> El Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 11 or RO Facility) ANNUAL <br /> E l Controlled Bum 1 Hood Installation <br /> n Emergency Generator < 30 kw El LP/Natural Gas - Installation <br /> • <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale • <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly ANNUAL <br /> t ";,�c7 Isemr� timer <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ }o 1 1 El Sparklers - <br /> Hood Cleaning ❑ ❑ / ❑ _ 1 I El Sprinkler System Installations <br /> Hood Suppression D ❑ ❑ Cl ' . I El Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch. RoofinglTar Kettle <br /> Fire Pumps a Waste Tire Storage ANNUAL Valuation of Project <br /> Fire Works • <br /> Flammable Application- ANNUAL <br /> Fuel Tanks <br /> Other: 1 <br /> Contractor IF <br /> G ��. 1 Compan wi .. .c, e, <br /> Signature Registered 'Wm/ Fee Current Ml <br /> Address 3 ■ • - . - Ih. .. - r License # (E F. ' i 7 b b t 0 N 3 ,. <br /> ELECTRICIAN' Company <br /> Signature <br /> I Registered Y / N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature I Registered Y/ N Fee Curr Y/ N <br /> Address 1 <br /> ` License # 1 <br /> MECHANICAL Company <br /> Signature Registered Y / N j Fee Current ` Y / N I <br /> Address I I License # <br /> OTHER Company <br /> Signature <br /> Registered Y / N Fee Current Y / N <br /> Address I _ ! License # <br /> Directions: <br /> All 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:Uappraiser.pascogov.com) <br /> • <br />