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- 813 - 780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received I /- / 1L) J Phone Contact for Permit 1 J I I I <br /> Owner's Name 1b*-i , //5 ‘ LaGf,'G a e ?a/ I Owner's Phone Number I ?73 I 1 74v2 114/Gay 1 <br /> _ <br /> Owner's Address I c / 7 Lvi/2F - Zetrssi Zjd�ri-i,!/ `' 35ry0 I <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 1 I <br /> Fee Simple Titleholder Address I I <br /> Job Address <br /> I Lot # <br /> Sub Division Parcel # I I <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> LI Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw 0 LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL = Places of Assembly- ANNUAL <br /> PM y ��I WA Other <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I 7 Sparklers <br /> Hood Cleaning ® ❑ NI ❑ I I n Sprinkler System Installations <br /> Hood Suppression ® ❑ x I J n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> E Flammable Application- ANNUAL ( I Valuation of Project <br /> ri Fuel Tanks <br /> 0 Other: I <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( <br /> 1 License # I I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N 1 Fee Current 1 Y/ N J <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N . 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER <br /> Company L <br /> Signature p Y ► vrr rt ± . , . � i L <br /> Registered [r #j Fee Current M <br /> Address I I License # I 2,94 $ X00;/ li 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 />