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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit I n / 3 11 .7 3 k II 2i11 <br /> Owner's Name 1 ./4 /'t 1/L r5 fv.s 7 , . '-- ° I Owner's Phone Number 1 S /3 1 76-0 1 1 a/ € <br /> Owner's Address 1 `7'6 `7 4 /R PD Q 7 a d 2e PN y✓Q 14i /= L - 3 CY - 4- <br /> Fee Simple Titleholder Name I AM ve 7s ,w s 7 S 5 ° Titleholder Phone Number p / 3 '78o g r k <br /> Fee Simple Titleholder Address I y y5 ,y „d / A .2e0,/ye y i t t % ici 331' ," I <br /> fs <br /> Job Address 1 Lot # <br /> Sub Division I Parcel # I /.3 2h 2/..- v o 8-0 — c 0 c co — 0, hf 0 <br /> D Bio- Hazard Waste Storage - ANNUAL J 1 Fumigation Tent <br /> Ei Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum I] Hood Installation <br /> Ei Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 0 Emergency Generator > 30 kw r LP /Natural Gas - ANNUAL Sale <br /> Ei Fire Protection Maintenance - ANNUAL 171 Places of Assembly - ANNUAL, <br /> y em um Other <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum 11 <br /> Fire Alarm I ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning I ❑ ❑ ❑ I I TI Sprinkler System Installation <br /> Hood Suppression 0 ❑ ❑ ❑ I I 7 Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation Ti Torch Roofing/Tar Kettle <br /> I Fire Pumps El Waste Tire Storage ANNUAL <br /> Fire Works <br /> n Flammable Application- ANNUAL 1 I Valuation of Project <br /> I Fuel Tanks <br /> Q Other. I I <br /> Contractor Company ,/A mkt- 7s Ao S? 5 ,' 0 <br /> / <br /> Signature 6� Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N I Fee Current I Y/ N I <br /> Address I ( License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ 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/ N I <br /> Address I I License # 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 />