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013 480 -0020 City of Zephyrhills Fire Fax - 813 -780 -0021 <br /> Permit Application <br /> D ate Received Phone Contact for Permit r ------- 1 1 1 1 <br /> Owners Name V &5 brook M h et � , // L- D r �J ,4 1 / Owner's Phone Number 1373 1 ( Z) 1 vv/ 71 <br /> Owners Address i jj' f 0/ j? ! r 0'-1 �/1 i / ,- /-t 'Ali / / 33$ / 2- I <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 I 1 I <br /> Fee Simple Titleholder Address I <br /> i <br /> i <br /> Job Address $ R /� Lot# <br /> Sub Division Parcel # I <br /> I Bio- Hazard Waste Storage - ANNUAL (] Fumigation Tent <br /> I Comm Exhaust Kitchen Hood!Duct ri Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Burn n Hood Installation <br /> Emergency Generator < 30 kw n <br /> LP Natural Gas - Installation <br /> I Emergency Generator •• 30 kw I J <br /> LPNatural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> N (Qtrly l (Semi i p Other i Z i�j' Spnnkler A 0 1 1 Recreational Burn �// <br /> =ire Alarm J 7 Cl 1 1 1 1 Sparklers <br /> -food Cleaning 1_1 ;7 O J 1 1 n Sprinkler System Installations <br /> lood Suppression 1 J ❑ D 1 1 1 1 Standpipes (Sprinkler Sys) <br /> I e Alarm Installation I I Torch Roofing;Tar Kettle <br /> FR <br /> u <br /> -e Pumps n Waste Tire Storage ANNU r <br /> =ire Works <br /> =tamabte Application- ANNUAL ' ( Va ua ton of Project <br /> 11 m Duel Tanks <br /> I I Other. I I <br /> Contractor <br /> ��' <br /> Company r i / /.e f c. AMF r p <br /> Signature Registered Y 1 N Fee Current Y! N <br /> Address - Q 9 ninferwa d; 2 License # I <br /> ELECTRICIAN `s •is j ? i Company <br /> Signature Registered YIN I Fee Current I YIN I <br /> Address I <br /> I License # I <br /> PLUMBER Company <br /> Signature Registered Y N I Fee Current 1 Y .' N I <br /> Address I <br /> I License # I <br /> MECHANICAL Cony 1 <br /> Signature Registered Y 1 N I Fee Current I Y! N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y! N I Fee Current I Y r N 1 <br /> Address <br /> ‘ # I I <br /> Directions <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized tOr copy of signed contract with owner) <br /> If over $2500, a Notice or 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 ihttp /,appraiser pascogov corn, <br />