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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> 1 Permit Application <br /> )ate Received � - Z. Z-'�� Phone Contact for Permit <br /> !. ., ,_. . .dr, . . . '_ AW3R'bre&'W.x,-�t"�R,��i-w.i4.«,uee�k.xr k:.x-5e YAC... �, a .l. d"ii°!# 'a9tiW`e.,n..{ .. , .d . <br /> ��e'������.�-�.,� � 0 0 <br /> hnmer's Name JSIC� �C�1�^�3e LEd��z=� /��c w�c�/,�<� C/�C' Owner's Phone Number <br /> hvner's Address /�(S QO/� .S/�'i!Z"� Qj� z ��°�a�r,��z�� <br /> �ee Simple Titleholder Name Titleholder Phone Number � � � <br />�ee Simple Titleholder Address <br /> r. r �,�_.���� <br /> :�� ;��rrk��� . <br /> iob Address Lot# � <br /> iub Division Parcel# <br /> P . ,..�stn x.,-�.�w�',:,-,..,„rea..„,g _ , . -�. -e;.•�,#r��cx <br /> 1t�31�td0., -c,^r,. �f^�,."y�^*. - <br /> � Bio-Hazard Waste Storage-ANNUAL �� Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier�I or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LPlNaturel Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ! _ f „ <br /> �y emi �n er � �(�"�U <br /> J <br /> Sprinkler � ❑ ❑ ❑ r� � Recreational Bum _/ <br /> Fire A larm � O ❑ O � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br />� ..._.. - - :-�r��,x, . ��_ .� <br /> Contractor �� Company <br /> 5ignature —.--�- Registered Y/N Fee Current Y/N <br /> Address License# <br />=LECTRICIAN Company <br /> 3ignature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />'LUMBER <br /> Company <br /> 3ignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> NECHANICAL Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />�THER <br /> Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address License# <br />)irections. <br /> Fiil 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 aker submittal date Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />