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813 - 780 -0020 City of Zephyrhills Fire Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received .- 1 (' bO/ I Phone Contact for Permit I g V 3 114/C I 6 c.t69 <br /> Owner's Name I So Al ^-‘-(5 G Q3 Q I Owner's Phone Number I 11 '2 1 42.72 <br /> Owner's Address 1 G D (o 6 k( B( ,c0 2-e-/k y f 4671 3 3 <br /> Fee Simple Titleholder Name 6 Titleholder Phone Number I <br /> Fee Simple Titleholder Address I <br /> Job Address 66o. &°-� ( J (d d 2-41 2r' ?3 5 Lot # <br /> Sub Division I Parcel # I <br /> n Bio-Hazard Waste Storage - ANNUAL = Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum In Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw = LP /Natural Gas - ANNUAL Sale <br /> Il x l Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ry (Semi) (a Other <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression l"� 7""' ❑ ❑ ,k 1 1 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarrn Installation In Torch Roofingfrar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> El Fire Works <br /> El Flammable Application- ANNUAL I 440D I Valuation of Project <br /> 0 Fuel Tanks <br /> 0 Other: I <br /> Contractor Company� /e. 6 l,gG <br /> ' /� <br /> j'■ % r /L / <br /> Signature .. Registered Y / N I Fee Current 1 Y / N <br /> Address I P O. /,3 O)( Ns L 1 Q 'l-G./.S 3'1 I License # I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N . I Fee Current I Y/ N <br /> Address I I License # ( I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N _I Fee Current 1 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 />