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813-7b J-0020 <br /> City of Zephyrhills �Fir:e FaX-s� �-�ao-oo2� <br /> PeRnit Application <br /> �)� () ��Cj/// Phone Contact for Pertnit ��5 I� <br /> �ate Received ��.�°-� �,,, ��„�„a� m�;a.- �,�=--�--•_--°^...tv.._..-. <br /> aaa �.�-.� "w.- ����s� ��...,.�.�..._.,.....�.........�.. --- /� A <br /> � �,� •' L �� ���' ��T/-f Owner's Pho�e Number � �3 s�7 � • / �s <br /> )wner's Name f <br /> )wner's Address � ��� � `' " ! �� ^���� �� � �� � � <br /> ee Simple Titleholder Name Titleholder Phone Number �� <br /> ee Simple Titleholder Address - � . � - - �..:e�; ;;�_: <br /> �'�'�':. ':�,�"��' • � <br /> ob Address ��/ /v�� W �� 7 �` , � ��� � ��' Lot # <br /> Parcel # <br /> �ub Division -�� <br /> � Bio-Hazard Waste Storege - ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material �er 11 or RQ Facility) ANNUAL <br /> a Controlled Bum a Hood Installation <br /> � Emergency Generetor < 30 kw � LPlNatural Gas-Instaliation <br /> � Emergency Gene2tor > 30 kw a LP/i4aturdl Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> � y emi n er � <br /> ❑� 0 � a � � <br /> 5pri�kler ❑ ❑ ❑ Recreational Bum � � <br /> Fire Alarm � O ❑ ❑ Sparlclers � <br /> Hood Cleaning � O ❑� a Sprinkler System Installations <br /> � p p � � Standpipes (Sprinkler Sys) <br /> Hood Suppression � � <br /> � Fire Alarm Installation � 7orch RoofingfTar Kettle <br /> � Fire Pumps a\Naste Tire Storege ANNUAL <br /> a Fire Works �� <br /> � Flammable Appiication-ANNUAL Valuation of Project <br /> � Fuei Tanks <br /> a Other: <br /> �ontractor /� , 7 Company / �'' S � G'�� <br /> Signature c3`- �� �� Registered Y! N Fee Curtent Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License f# <br /> PLUMBER Company <br /> Signature Registered �' /�1 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 Registered Y/ nl Fee Current Y! N <br /> Add2ss License # <br /> Directions: <br /> Fill out application completely <br /> Owner & Contractor sign back of application, nota�zed (Or, copy of signed contract with owner) <br /> If over 52500, a Notice of Comme�cement is required (Mechanical work over $5000) <br /> Supply hvo (2) sets of drawings with applicabie documentation <br /> Allow 10-14 days for review aRer submittal date. Parcel #- obtained from Property Tax Notice (httpJ/appra+ser.pascogov.com) <br />