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' 813 -780 -0020 City of Zephyrhills Fire <br /> Fax - 813 - 780 -0021 <br /> Permit Application <br /> Date Received I 2- 1 t 1 Phone Contact for Permit <br /> Owner's Name 5% l v J Coo (f e jvJ Owner's Phone Number 1 g /3 l I7es J f `2 - 2 <br /> Owner's Address I 3 G�' k C i J h Lt 0� i.e D r 2 h,' 11 5 33 S�-f Z._ <br /> 1 l <br /> Fee Simple Titleholder Name /i �� Titleholder Phone Number 1 1 1 I 1 I <br /> Fee Simple Titleholder Address I <br /> . :a.r.:. <„,ag, immi aa:,, :fix "' €st%:. a w`''�c4II IEME , ME ' <br /> Job Address I .� b � 6- V b k8 JS.� ,: J r Z (-}-r (( 5 3 3 s.'_C., f 2 Lot # <br /> I <br /> Sub Division <br /> Parcel # I <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL S. e /, <br /> a Fire Protection Maintenance - ANNUAL n Places of Assembly -ANNU • L 4 )/// -' <br /> �Qtrlyl'Semi 4� Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum r <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I n Sprinkler System Installations <br /> Hood Suppression Cg ❑ ❑ j I I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL <br /> / Sc- 1 Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> ,,< .,, <br /> s. Bit & <br /> �a�a, <br /> Contractor <br /> Company -j`It 6 <br /> 4 e- <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address A Q , aoic. e.A Lend 0 rl.-4kCo • (( License # I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N , Fee Current I Y/ N 1 <br /> Address I I License # <br /> PLUMBER I I Company <br /> Signature Registered Y/ N J Fee Current I Y / N I <br /> Address I I License # <br /> MECHANICAL I Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N j <br /> Address I I License # <br /> OTHER I I Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N - I <br /> Address I I <br /> License # J <br /> ....:....,,: 0..,... i........a w: aa i . >.a �H. imm4, „g,..r u_ asx. ' u,. ,i, „,x,. ...i a °.:M ,vw, ,c.....a ... >a a,. .k. .., c: .�t,,,,... » .: :.�....,,,,..,r.� >a,.�:a,. rmiiimi .,.... <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 />