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813- 780 -0020 City of Zephyrhills "Fire• / ��� Fax -813 -780 -0021 • <br /> Permit Application i ft 1 <br /> Date Received f I - Phone Contact for Permit <br /> >c .»�.�.fi,'',e:.„,,w .. �a»m,:aas.+.s..« . •: re- ssa,:., ro ua^.,,sss;.:-;.. - _ - _ rur,w..».»a,.s:' .e.wo...w.� �a_,d z <br /> Owner's Name k l aw Nut"- t ..r pity Owner's Phone Number <br /> Owner's Address 0-9-D- 0 3 SI • . 54• Pei-e f F L 5 "3 '7 1 1 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> • <br /> Fee Simple Titleholder Address I I <br /> Job Address CL7 S 3 CS a. 11 GI ✓d. - a e 1 r N 1 Is , FL 3.._5e/. Lot # <br /> Sub Division Parcel # O d _a (P ^, 1 — 60 / O — o P-y00 00i 0 <br /> d''"'`d'7ia^•?« -. a,v dTxsrs3'isx: *...:,.- i.src.:�:'s n Bio- Hazard Waste Storage - ANNUAL ` r Z n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct C l I I Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I Controlled Bum I I Hood Installation <br /> I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> 57...re Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> rly 'berm' raj maw <br /> Sprinkler I 10 ❑ I I Recreational Bum <br /> Fire Alami I ❑ ❑ ❑ 1 1 I Sparklers <br /> Hood Cleaning I ❑ ❑ ❑ 1 1 Sprinkler System Installations <br /> Hood Suppression I ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation 71 Torch Roofing/Tar Kettle <br /> F 1 Fire Pumps I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL ( I Valuation of Project <br /> I Fuel Tanks <br /> Other: I <br /> . .�six_":..���i msx-� as z. ..� a. -.�z. =c..as:o.s.R: as¢, ::;x�`»:'i3rz> a, xe.- f:..:. r�a#'a.�.�<r , . .�x �. , � >::w <br /> Contractor p/ F re. f1 Il°C �S 1�$•• <br /> Signature VVt Company -k- Registered Y / N � Fee Current I Y / N ttt <br /> Add ess ; 5 co a— 5 tit. N EN44L4•p 6-E . —904, 7L I License # 'g s 07-7 6606) =6671 <br /> ELECTRIC • N Company I <br /> Signature Registered Y / N I Fee Current I Y/ N] <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered L Y / N 1 Fee Current 1 Y/ N I <br /> Address I I License # 1 I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 , I License # I I <br /> OTHER . Company KIET � . i � 1_ <br /> Signatur= Registered Y / N Fee Current Y / N <br /> Address ", / c 9 i■-) ) , /i r License # fa 0 0 aQD <br /> Direction <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 />