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a�3-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> - _ Permit Application <br /> Date Received Phone Contact for Permit � � � <br /> Owner's Name �'"^�. CO/l"r !7'SSI9 O� 7� � �/P � � Owner's Phone Number � � � <br /> Owner's Address �Q �3 �p��Q ��� �G �. �'�L '�l� <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> Job Address 333 ���r� �t /l,S L Lot# � <br /> Sub Drvision Parcel# 3��p?�" �"dC���—U7�fJ�—C.�'.�� <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> tr y emi �n er /� O(�� <br /> Spnnkler � ❑ ❑ f�L B � Recreational Bum �� 3 v <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar 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 /> Contractor Company 'fC � r�'/'e. C, <br /> Signature Registered /N Fee Current Y/N <br /> Address p —� ��cense# O � 7� ppQ [ a2 <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> S�gnature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER ., � Company <br /> - a <br /> Signature �, � ' Registered Y/N Fee Current Y/N <br /> Adckess� �� r�� License# <br /> b, .. �fi� '��,n..,.�: . <br /> Directions: �.�-' <br /> -•r��-^'�'wc---�'0w' re^il�',...yr"'.+�"".: <br /> Fili oufa�`piication 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 after submittal date Parcel#-obtained from Property Tax Notice(http.//appraiser.pascogov com) <br />