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813 - 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 1 Phone 2 / <br /> f b / / I `` one Contact for Permit fj �/ 1 1 I �9h 11317W <br /> Owner's Name 1 / &0/77r" e40 or L 16 l(s 1 Owners Phone Number 1 f? 782 1 .S3-7 <br /> Owners Address I 3 2-3 / 5 ,fir_ 2 a )4'4(7(5 3 3 2_ <br /> Fee Simple Titleholder Name I 1 Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address I 3 6 2-3 i J i(0 < - 2 ,e / / 3 35-Y Z Lot # <br /> Sub Division 1 / Parcel # I <br /> El Bio- Hazard Waste Storage - ANNUAL n1 Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum [) Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 11 Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> rE Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> FQry (Semi) j Other <br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm F ❑ ❑ I I n Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ 1 1 f Sprinkler System Installations <br /> Hood Suppression ❑ pJ ❑ I I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> EI Fire Works <br /> E Flammable Application- ANNUAL I /5 — 1 Valuation of Project <br /> Fuel Tanks <br /> 0 Other: <br /> Contractor ,_ Company �7�- – ',1. A7 4 �I'rrtG <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N 1 <br /> Address I A 0 , Qo)! $$$ L,tN o< 0 't..4,`-7 3 cr63 y' I License # <br /> ELECTRICIAN 7 Company <br /> Signature I Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address ( I License # <br /> OTHER Company <br /> Signature Registered Y/ N J Fee Current 1 Y/ N <br /> Address 1 License # <br /> Directions: », ,. ...... , .7... <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 />