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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 Permit Application Date Received . L Phone Contact for Permit I l ( I Owner's Name I ZE- Z- Co IVY 1_5 •■ S I Owner's Phone Number I 1 1 l I I Owner's Address I I Fee Simple Titleholder Name Titleholder Phone Number I Fee Simple Titleholder Address I 32 _n _ Job Address 7 ? Q� -� �i (', s( L\-&s? 1. o� �5 Lot# I Sub Division I Parcel # I I Bio- Hazard Waste Storage - ANNUAL FT Fumigation Tent El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL n Controlled Bum ED Hood Installation n Emergency Generator < 30 kw n LP /Natural Gas - Installation n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale El Fire Protection Maintenance - ANNUAL = Places of Assembly- ANNUAL r y u jj jj mu Other Sprinkler 0 ❑ ❑ ❑ n Recreational Bum Fire Alarm E ❑ ❑ ❑ I I E S Hood Cleaning n ❑ ❑ ❑ I I Sprinkler System Installations Hood Suppression E ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) n Fire Alarm Installation n Torch Roofing/Tar Kettle Fire Pumps n Waste Tire Storage ANNUAL E Fire Works n Flammable Application- ANNUAL I I Valuation of Project Fuel Tanks n Other. I 72-- 3 S'LLS L ' i 0 - "E-s- „ s `t={ \ �^- I Contractor C \\\ Company `r�Dj 1.. 'V.1 .\ I•-FF.-.. � � , a� , Signature I Registered N I Fee Current I Y/ N I Address I \ License # I ELECTRICIAN \ Company I Signature I l Registered Y/ N I Fee Current I Y/ N I Address I I License # I PLUMBER Company Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I I MECHANICAL Company Signature Registered Y/ N I Fee Current I Y/ N I Address 1 I License # I OTHER Company Signature Registered Y/ N _I Fee Current I Y/ N I Address I I License # I I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)