|
313 =780 -0020 J! �� - ,j[-, City of Zephyrhills iF Fax- 313 -730 -0021
<br /> /aDJ� ��**��" Permit Application
<br /> - J Phone Contact for Permit
<br /> Ric iv =d
<br /> Dare �+
<br /> Owner's Name S TM ?T,F;XGR T NNFT,L Owners Phone Number 813 626 `5 4 8 2
<br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610
<br /> •
<br /> Fee Simple Titleholder Name - - ' Titleholder Phone Number
<br /> Fee Simple Address .
<br /> F :,. -� <�.!" e M=� :-�. _ � ". _ A:A � , r: �r��- y...tir.- r,,.�_:�..."$ ... .__ ...:�_- ,'mss.... �,...._ �_S�.mi�..� _c�.. ��:L:.�s 5.
<br /> . .._� . ` S2?z3 Dal nl� I`Z � , � 3��IO y L sP , t INL�`J11
<br /> Job Address l 2 en yrh; ip L i:, ye, Lot #
<br /> Sub Division Parcel #
<br /> fr s,._-. " . M w mx .. w,.r_: '..:. m:-;,._,_. , . _..__. - te r:....- - >."" fie � ::;. a.,_._.__....,�.
<br /> Bio- Hazard Waste Storage - ANNUAL 1 Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier If or RQ Facility) ANNUAL •
<br /> • Controlled Bum Hood Installation
<br /> I ` Emergency Generator < 30 kw ! LP /Natural Gas - installation
<br /> _ Emergency Generator> 30 -kw LP /Natural Gas - ANNUAL Sale - - -Th
<br /> Fire Protection Maintenance - ANNUAL I Places of Assembly ANNUA .. /
<br /> � (ltrl I Semi l' Ant I Other c�
<br /> Sprinkler: El ❑. - I Recreational Bum CJ
<br /> Fire Alarm ❑ ❑ ❑• I- , I , I Sparklers
<br /> ' Hood Cleaning b ' ❑ ❑ I I l Sprinkler System Install '
<br /> Hood Suppression - - ! ( 0 O _ , - O l 1 Standpipes (Sprinkler Sys);.
<br /> I ; ( Fire Alarm Iristallation - Torch Roofing/TarKettle`
<br /> I '' r ` Fire Pumps pi Waste Tire Storage ANNUAL • . I • Fire Works • ,
<br /> Flamrnabfe Application- ANNUAL I Valuation of Project • { Fuel Tanks
<br /> I L . Other:
<br /> Fa r. ^_ .^s_�,. - * .:'F m: �?• ?:L .- ";."4su:. - ,:o^,r.: -.c ='rg .,� . m'., -m5 '•g :t6Fj.. r `rdv�__"4: 3rM arirr.MS ^-. ":_"�` -irTZ = a . x "-:
<br /> Contractor Company 3 CYi"� K.R, -. -°t 1(
<br /> Signature Registered Y/ N Fee Current Y/ N I
<br /> Address I I. License # ..I I
<br /> ELECTRICIAN : ' •• . Company ,
<br /> Signature - - : Registered Y / N I Fee Current I -.. Y / N, I
<br /> Address I License # I
<br /> PLUMBER ... . Company '
<br /> Signature Registered Y / N j Fee Current- Y f N':' 1: • •
<br /> Address I . . . I License # ` I
<br /> MECHANICAL • Company
<br /> Signature . Registered Y / N j Fee Current Y / N -
<br /> . Address I.,,- ::.. . I License # I I
<br /> OTHER • Company • . .
<br /> Signature Registered Y / N , Fee Current I Y / N
<br /> Address License # - I
<br /> >z ,,,„-a - „,..�.,,� s. _aa_�_.. __ ..__-
<br /> _.� r� - _�.��.� ,.- -�� - _ -- <s.�, - �=,� -� . -„�... -« ^-•-
<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 app[icab(e documentation -. - 10 -44 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http:fiappraiser.pascogov.com)
<br />
|