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81 3 78 0 -0020 City of Zephyrhills Fite; ( . 3 % e ' Fax - 813- 78J0021 <br /> Permit Application r <br /> Date Received Phone Contact tor Permit <br /> Owner's Name S TYPT,F;X(7RTNNFT,L Owne-s Phone Number 813 1 626 1 15482 <br /> • <br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610 . <br /> Fee Simple Titleholder Name • ' Titleholder Phone Number <br /> Fee SimpleTitleholderAddress . <br /> " -•-1 1 r - ,. _.: ' a _ E .c,:.:.� & '- - :M 17 - . �F_ iv—.� -- „,, _ .eF__. sM�-= c::=-_,. <br /> . Al C <br /> Job Address ' - 7. ,, v - 0 1 h • •S 5() , a rGn PIM I n # <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I r <br /> Controlled Bum I v Gam^ ( - C o ( <br /> I ? ' Emergency Generator < 30 kw I j <br /> Emergency <br /> I•- > 30 -k I <br /> I I Fire Protection Maintenance - ANNUAL I I J 1 Otrly1 1Semi 1 iAnl 1 Other ” 1 <br /> Sprinkler. l ❑ ' O D. <br /> Fire Alarm , I ❑ ❑ • , t : I 1 I _ U�/ Q_ (14,U I V� <br /> Hood Cleaning I 1 i7 ❑ ❑ 1 SJ. <br /> Hood Suppression f o ❑ . . _P = I.. I .' \ @,i <br /> f Fire Alarm Installation ' • I 1 <br /> t I Fire Pumps • • . <br /> II Fire Works • <br /> J:-: : I Flammable Application- ANNUAL <br /> [ <br /> I I.. Fuel Tanks .. <br /> I f Otf:ier I • <br /> _ <br /> Contractor / Company (�ti KR.w.-e. t.( <br /> Signature ` - Registered Y / N j Fee Current I' Y / N I • <br /> Address I :, I. . License # I <br /> ELECTRICIAN Company ., <br /> Signature -` " _ . t . ' Registered Y / Ni Fe & urrent Y / NI:. f • . C <br /> I, : I - <br /> Address I I License # I l <br /> PLUMBER _ Company , <br /> Signature - Registered Y/ N ' I Fee Current- 1 Y114.,' I : ' - <br /> Address I I License # • ' I <br /> MECHANICAL Company • <br /> Signature , Registered Y/ N . 1 Fee Current Y / N j <br /> . Address I, ; I License # I <br /> OTHER - Company - . <br /> Signature Registered Y / N I Fee Current Y / N,] <br /> Address License # I <br /> Directions: <br /> Fill out application completely_ _ <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) 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.pescogov.com) <br />