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s� �-�ao-oo2a <br /> City of Zephyrhills-Fir�• Fax-s�3aeo-oo2� . <br /> , Permit Appiication - <br /> � <br /> Date Received Phone Corrtact for Pertnit 4 . A r,. _ f✓ _, ^^_ ^ , N „y . <br /> �sz�:r� °° _ <br /> n .� ,_ �' . <br /> - -.�. - �<.� ,. <br /> . . .-� .c +- _� - <br /> ,_ ;. .- , .-n::k-�'..��r,��_.. - .__. __�.,..,. �. _: . _ � �� �� L�----� <br /> Owners Name ANDERSON PRE S Owners Phone Number <br /> Owner's Address 51�F ���' �� �� �� <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Name <br /> Fee SimpleTitlehoiderAddress ,�., s �-�?°��<�' <br /> -��;.- :.�;'�,c'�v";!���.>+:�:<'�'' > , ;.. .�.s � .��, s.'.�.' �.°.s:�;, �� s'.'�y°+�f�" ��".'� :`��`S'�.�,':`-.":`�:��.:��; � <br /> ' � �x ",:..° `.i-`:. , - • . '� <br /> JobAddress GOLDEN CORR.AL C7HSS GALI� BLVD. Z��H — Lot# <br /> Paroel # <br /> Sub Division , , �. - -��.�:€�;�'d�:>=�.�a `=�-�:::�.��:=�:�'"°� <br /> .... _ _ - � . r°' ���, „ . :. �:5:�, <br /> Q Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generetor> 30 kw � LP/Naturai Gas-ANNUAL Sale <br /> � Fire Protection Mairrtenance - ANNUAL � Places of Assembly-ANNUAL <br /> �rTJ emi � � a <br /> Sprinkler � ❑ O ❑ Recreational Bum I I �� I <br /> Fire Alarm � � ❑ ❑ C� � Sparklers /� <br /> Hood Cleaning � ❑ ❑ � C� a Sprinkler System Instaliations j X <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkter Sys} <br /> Q Fire Alartn Installation � Torch RoofinglTar Kettle <br /> n Fire Pumps � Waste Tire Storage ANNUAL <br /> U Fire Works <br /> Flammable Applica6on-ANNUAL Valuafion of Project <br /> L_J Fuel Tanks <br /> � Other. =y �,��,... ; - �,_,; <br /> ;�'- _ <br /> Contractor Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature <br /> Registered Y/ N Fee Cu►rent Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature <br /> Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature <br /> Registered Y/ N Fee Current Y/ N <br /> Address License # ���� yp � � y <br /> .��,.�,.�. �x,.� ��- .� - <br /> Directions: <br /> FII out appiication completely. <br /> Owner & Contractor sign back of application, notarrzed (Or, copy of signed conVact wRh owner) <br /> ff over S250Q, a Notice of Commencemerrt is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documerrtation <br /> Allow 10-'14 days for review after submittal date. Par�el #- obtained from Pmperty Tax Notice (httpJlappraiser.pascogov.com) <br />