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813- 780 -0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> Permit Application <br /> Date Received I 1 Phone Contact for Permit I I i I I I <br /> Owner's Name I ()vie .SA U/G}/C II/TAPrw0%/ ad(t#,c /(r I Owner's Phone Number 1P/3 / I 1 7 I I /J&9 1 <br /> Owner's Address I S6. 6 .?err =' rC era- r Z,v41,/I ,L I <br /> Fee Simple Titleholder Name I Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> Job Address 1 Lot # I I <br /> Sub Division 1 Parcel # I I <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RC) Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> [j emT Eza Other <br /> Sprinkler El ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm D ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning I7I ❑ ❑ , 1 1 n Sprinkler System Installations <br /> Hood Suppression ® ❑ 1 ❑ I I n Standpipes (Sprinkler Sys) <br /> 11 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> n Other: <br /> Contractor Company <br /> Signature Registered Y/ N J Fee Current l Y/ N J <br /> Address ( I License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y / N 1 Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address ( I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N <br /> Address I I License # <br /> OTHER Company tSesiee,7,'e �r � w,. C FQcsi > LLC <br /> Signature ej= '��� Registered N Fee Current 1 N J <br /> Address I 1 License # 12 4S 9/!rG 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 />