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. 41 1 1 (d i ( t r i <br /> 813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit - <br /> Owner's Name M V W iwi ZG�JI - 1 r ti1 IS I 1 $1 I I 58.8c �� tl (1 5 ` QQ ` t_C Owner's Phone Number 1 Z <br /> Owner's Address 2 ( f 2 1 (uil ew cr / M NA-04 O e_ - I 3 <br /> Fee Simple Titleholder Name F � ' Titleholder Phone Number I <br /> Fee Simple Titleholder Address I <br /> ...:_ yes „,. 39. . ',.' :- - '131.... r . .... „, a <br /> Job Address ,-- L! /P/l/ ,g 1,e- Ze r4, /Is ft 3 t i Z Lot# I I <br /> Sub Division / P <br /> Parcel # (p" <br /> 4 Co) Jo -cam 30o vow <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RC) Facility) ANNUAL <br /> F - 7 Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 1 Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> El ISemi1 J Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Burn <br /> Fire Alarm n ❑ . ,6-1 I Ti Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n F ire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n F lammable Application - ANNUAL I I Valuation of Project <br /> n F - uel Tanks <br /> n Other: <br /> �, ="="e'7' <br /> _ <br /> Contractor <br /> �� � % ��w Company - MS • or 1 <br /> Signature <br /> Registered r.� Fee Current laTIMI <br /> Address Q W, �, / v , � t G / , - L 32�p License # ( t f c'oc i, ") I <br /> ELECTRICIAN Company 1 <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address ( License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I <br /> 1 License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> 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 />