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813 -780 -0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> Permit Application - <br /> / <br /> ate Received 1 - // J - ,/ Phone Contact for Permit IIPMEM M� I 067' <br /> wner's Name %/ 72c.)4L/ 74 JZ I Owners Phone Number I 1 1 <br /> wner's Address 1 _ ? ` / s ApE ZEj0y,ti/Pees cc <br /> :e Simple Titleholder Name I Titleholder Phone Number I I <br /> .e Simple Titleholder Address <br /> _,. v!. n; sa Sr . <br /> ,, � .. *^"Y a " SF '£ s a�?'�S 2 r ,..., .. � . s , /� � /4 5 < .... a:'q"`. $+'J b�'3% '°- r '?�' . .. <br /> rb Address 3 1�J 2 cr ,(f6 Z-X Y/e// � � _ Lot # <br /> ib Division I Parcel # I 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 /> 0 Controlled Bum n Hood Installation <br /> n 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 n Places of Assembly- ANNUAL li <br /> IQtriy) 'Semi) j Other 4t/i 111 <br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum <br /> '.1:::::: <br /> c -'_ FFire Alarm_ –> n ❑ � n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps = Waste Tire Storage ANNUAL <br /> El Fire Works <br /> n Flammable Application- ANNUAL ( ' Valuation of Project <br /> Fuel Tanks <br /> Q Other I I <br /> 7ntractor Company ggien' J6N-Aen 69 mt. <br /> gnature V,A G6,- Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I I License # <br /> _ECTRICIAN Company I <br /> gnature I Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I I <br /> _UMBER Company <br /> gnature Registered Y / 1 ' ' <br /> Address I <br /> 1 t <br /> ie,.. <br /> ECHANICAL C / <br /> gnature RE 4 0 <br /> Address I I Lici (11.-- <br /> THER Corr 7 <br /> gnature Regi, <br /> Address I ( Licen: <br /> rections: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owne <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 Proper <br />