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ei3-7so-o02o City ofZephyrhills Fir:e� Fax-e�3-�ao-oo2� <br /> � Pe�nit Application <br /> late Received � Phone Con ��� � <br /> a:sa:.:� ;�,�.«�ar;t�.. ..a,.......�.. _.__-�-.,__.._ =.. �,� �,;=--,°=-sr„r tacYfor Pertnit I TJ I <br /> —= Y= ^ .�a�4.L?C'�� .4sL�'zi�'i, - ��-, <br /> )wners Name �, LQ ��/4 l"� Owners Phone Number � 1 f �, �5 <br /> )wners Address / * � � �/�/l / �J� � �/�� L 3 � <br /> ee Simple Titieholder Name Titleholder Phone Number �� � <br /> ee Simple Titleholder Address <br /> �.C� �{ .'.." _. ' ��,.,�,__ �,,�7c��1`.L.��. �.x4�� -�i' +. ixs� y _ �. � _ �"�.L'�5i£s'�i�ra+s:s:zcr3>;c-..n���..,.,c:� <br /> .�»—_-�.k t `+t.a`: <br /> ob Address �C/ /- / �/V (/ ,S L- G� I / �O�D C,��� � � (�D � <br /> Lot # <br /> �ub Oivision Parcel # <br /> ��� . <br /> s: <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumiga6on Tent <br /> a Comm Exhaust Kltchen Hood/Duct � Hazardous Material (Tier II or RQ Faciliiy) ANNUAL <br /> a Controlled Bum a Hood Installation <br /> a Emergency Generator < 30 kw a LP/Natural Gas-Installation <br /> a Emergency Generator > 30 kw a LP/Naturel Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � P{aces cf Assembly-ANNUAL <br /> r y emi � er a <br /> 5prinkler � ❑ ❑ ❑ Recreational Bum <br /> Fire Alartn � ❑ ❑ O � � Sparlclers � `j � <br /> � J <br /> Hood Cleaning O � O C_C� a Sprinkler 5ystem Installations �I I <br /> Hood Suppression � ❑ ❑ ❑� a Standpipes (5prinkler Sys) <br /> � Fire AIaRn Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> a Fire Works <br /> Flammable Application- ANNUAL <br /> Valuation of Project <br /> a Fue( Tanks <br /> a Other: <br /> : ontractor � Lz / Company � G� _ - <br /> Signature �y� '" � <br /> Registered Y/ N Fee Current / N <br /> Address License # <br /> ELECTRIGIAN Company <br /> Signature Registered Y/(�l Fee Current Y/ M <br /> Address <br /> License JF <br /> PLUMBER Compa�y <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # -, <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Company <br /> Signature <br /> Registered �' / N Fee Current 1' / N <br /> Address <br /> _ License # <br /> Directions: ' - - - <br /> "_"�`_=�-._: - <br /> Fill out application completely <br /> Owner 8 Contractor sign back of application, notarized (Or, copy of signed contract with ovmer) <br /> tf over $2500, a Notice of Commencement is required (Mechanical work over 55000) <br /> Supply two (2) sets of d2wings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from PropeRy Tax Notice (http://appraiser.pascogov.com) <br />