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8�3a8w;o2fl . City of Zephyrhills'Fir.e Fax-813-780-0021 <br /> Permit Appiication ' <br /> )ate Received - Phone Contact for Pertnit <br /> ;�:s�y�a!��c ar.a.,.�,�.r.,. e,�,� <br /> �......�.v W....�.:.,tif,�,.�.......�, ,,, <br /> huners Name S ���ry � 1 ssa C� t OwneC's Phone Number �/ U �� � <br /> �wners Address <br /> °ee Simple TiUeholder Name T�leholder Phone IVumber ��J � <br /> =ee SimpleTiUeholder Address <br /> ' ��°��'� <br /> Job Address 5� 3 `� S ` 3 U Lat # C <br /> Su6 Division Q r �� Paroei # '� - " ' -/(,) �p(� — (�O �{� <br /> �r:�:�;��m�.s�s+� <br /> � Bio-Hazard Waste 5torage - ANNUAL � Fumiga8on Tent <br /> � Comm Exhaust IQtchen HoodlDuct � Hazardous Material (Tier 11 or RQ Facil3iy) ANNUAL <br /> � Controlled Bum � Hood Installadon <br /> � Emergency Generator < 30 kw � LP/NaWral Gas-Installatlon <br /> Emergency Generator> 30 kw � LP/NaWral Gas-ANNUAL Sale �� O� <br /> � CJ <br /> Fire Protection Maintenance - ANNUAL a Piaces of Assembly-ANNUAL � <br /> �y em� ATn ar <br /> Sprinkler � p ❑ ❑ � � �reationai Bum <br /> Fre Alarm O ❑ � �� � Sparklers <br /> Hood Cleaning O O ❑� � Sprinkler System Installatlons <br /> Hood Supp►ession � O Q ❑� � Standpipes (SprinWer Sys) <br /> a Fire Alarm Installa8on a Torcfi. RaoflngfCar Kettle <br /> Fire Pumps � Waste Tire 5lotage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> � <br /> ConVactor Com a <br /> P �Y ° � � .G ��C�vY " t• <br /> Signature ' Registered Y N Fee Current N <br /> Address ,� 1 - � License # � b �� <br /> ELECTRICIAN Compeny <br /> 5lgnature Registered Y/ N Fee Curtent Y/ N <br /> Address <br /> Ucense # <br /> PLUMBER Company <br /> 5ignature Registered Y/ N Fee Current � Y/ N <br /> Address <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee CuRent Y/ N <br /> Address <br /> License # <br /> OTHER Company <br /> 5lgnature Registered Y/ N Fee Curtent Y/ N <br /> Address <br /> --� ---°.-�::.�.o:e,�.._.."._..v.__ <br /> Lioense # <br /> Directions: ---""`.`... "-`°"'°'".«- '- <br /> — - � �-�.::,w ,, _e�x.�e„ <br /> Fill aut applicaUon completely. <br /> Owner & Contractor sign back of applicatior�, �otarized (Or, copy of slgned cvntract wtth owner} <br /> If over $250D, a Notice af Commencement is required (Mechanip! work over 350D0) <br /> Supply twa (2) sets of drawings with applicabie dacumentaBon � <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained frorr+ Property Tax Notice (http:/lappraiser.pascogov.00m) <br />