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a��-�ao-oozo City ofZephyrhills'�ic�e� <br /> Fax$13-78D-0021 <br /> Permit Applicatian <br /> Date Received - p�Cp��{��pe�� :� 6 <br /> Owners Name �'�'/ ' ' "' ONmer's Phone Nurnbe� . . 1 5 C-��'J f��,~� <br /> � <br /> Owners Address '' � `/� �� � �� - f � � � � ~ �� , •- <br /> Fee Simpie T{tleholder Name �, �" �Trtleholder Phone Number �� � � <br /> Fee Simple'�itiehoider Address r <br /> 1 ^ ,7 � <br /> Job Address � %i C� ' � �.�� I ��� `I �" ��� I � �� Lot# <br /> Sub Division ' Par�el# <br /> � Bio-H�ard Waste 5�age-�ANNUAL � Furt�igatlon Tetrt <br /> aComm Exhaust FGtchen Hood/Duct � Hazar+dous I�Aate+ia!(Tier II or RQ Faci6ry)ANNUAL <br /> � Controlied Bum � fiopd Insmllaiion <br /> � Emergency Generator<30 kw � LPMaiural Gas-Irstattation <br /> � Emergericy Generator>30 kw � LPMahnai Gas-ANNUAL Saie <br /> Fre Protection Mairdenar�ce-ANNUAL � Places of AssemWy-ANNUAL <br /> .❑� � �� <br /> 5prinkfer O ❑ ❑ Recreadonal Bum <br /> Fire Alarm � ❑ ❑ � � Sparklets <br /> Hood Cleanin9 � ❑ L] ❑ � � SpritYderSysbem ktstallations <br /> Hood 5uppression � p p O � Q SlardpiP�ISPrinkle�5Y5) <br /> � Fire Alarm Instailativn � Tor�h Roofing/Tar Kettle <br /> F'ire Pumps � Waste Tirs 5torage ANNUAL <br /> Fre Works <br /> Fiammable Appficati�on-ANNUAL �_`� Valuation of Project <br /> Fuel Tanks <br /> Q Other. - <br /> Contractor ���y <br /> s�gnature ' Rayistared Y/N Pee curre►n Y/�� <br /> Address ' Licxnse# <br /> ����� ��v R sell Electrical Eonst <br /> Signature � < Registered Y/N Fee Ctment Y/N <br /> Addrsss ��# <br /> PLUMBER ���y <br /> 5ignature Regisbered Y/N Fee Cunerrt Y/N <br /> Address • Lieense# <br /> MECHANICAL C�pa�y �— <br /> Signature =Registered Y/N Fee C�nrent Y/N� <br /> Address Lice�ss# �— <br /> OTHER Com�ny �� <br /> signature Registered Y/N Fee Current Y/N <br /> Address ucenae# <br /> ' ' � YI 'Iwr� .sJ <br /> D�rections: <br /> Fll out apptfwtion completety. <br /> CT�mer 8 Corrtrachor sign badc of epplicstion.notaraed(Or,cbpy of signed co�tract with owner) <br /> � If over S250p,a Notice of Commanoement is required.(Mechaanicxl work over$50D0) <br /> 5upply two(2)sets of dtawings wtth applicable documerAation <br /> ,A{Vow 1 D-'14 days for revfew after submittal date. Parrxi#-obtained from Property Ta�c Natice(htlpJ/apprei�r.pascogov.com) <br />