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813 - 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> We Recei%gd 1 I Phone Contact for Permit I I I I I <br /> A <br /> Owner's Name I - e." - 6 P /'1 'f R.44 1 a -S l30 / I ED tjA l I Owners Phone Number I I <br /> Owners Address 1133 a 2- ■ st 7F PH y/or t L LS , F- 3 3,- <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address <br /> Job Address I C/ 3 - 'j O Z cYrid Si I Lot# I <br /> Sub Division I Parcel # <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> 0 Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL = Places of Assembly- ANNUAL <br /> L".ul7 emi Eja um. <br /> Sprinkler El ❑ ❑ � ❑ / El Recreational Bum <br /> Fire Alarm Et ❑ ❑ �1 I I 71 Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I—I Fire Pumps n Waste Tire Storage ANNUAL <br /> H Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor J Company �LG/.4/1(Cv� ff2G �101j?7oa s - ev1C. . <br /> Signature [/�� Registered Y/ N 1 Fee Current I Y/ N <br /> Address 1 11 3 Z f } flgeE, IV / It 327S21 I License # ( EF 200003 ( I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N . 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y / N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> I License # <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 />