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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> • • Permit Application <br /> Date Received 7'"Z�t Z ntact for Permit <br /> Phone Co <br /> ,., �„� --"' ->. ,� ..,,.. .u_.�.�..._y ,. ... - - ,. ., „< ��- <br /> ...-.......,..._..4.. tr..xse,a.w_-_:..s�.�:.r.-... ... �, .,..x....,;._ -�_ ,,....> ..,....,+.., ...<-.... .. .... . ........... .b..........,..... <br /> ., . . .. . _. .::�Y' , � � <br /> Owner's Name p � v f �oc-( Owner's Phone Number �' 7 8 3 g�6 <br /> OwnersAddress C����J� �r� ( D�d'� <br /> Fee Simple Titlehotder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> . <. � .� w.,.��7 .r.� �:s:'��.*w�'�ti7%'=° *-°-X�r�=; 3�-..:�a;a.<;�;.:x�;��'e .��3�+��». <br /> e•. <: <br /> C i" y � <br /> Job Address J 6C,i / C.� 7�/? �v►/ / � Lot# <br /> Sub Division Paroel# <br /> . . .., ,. ... . ���'-'a.S.. -e.'st�:'�F^-.'.sst�".?€�.�'+�rWS%,:��.t'�iN�';.?9Sa'�s6:(t�;..zra�:S� =�••�m. .. ..,a , . - � s, .:sy..�k;�.�.*^...&:s,�'8a2�`:t�ov'^�«;�G..,b.=� �.7'Tl'✓-�. . _ ., e ., , <br /> . , a 8"v �"��a4 , <br /> Q Bio-Hazard Waste Storage-ANNUAL ��Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> aEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emargency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembfy-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers ����Z 2� <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ I� � � Standpipes(Sprinkler Sys) <br /> QFire Alartn Installation � Torch RoofinglTar Kettle <br /> Q Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL r--� Valuation of Project <br /> � Fuel Tanks ' <br /> Q Other: � <br /> � ,. . � x {. . ..,.�...::'.r'"^, . . . . ^ .. - ..... Z° .'@' . A`.. . .�.. .v,. � . ' . <br /> Contractor �.�..— Company /—;• �L <br /> Signature Registered Y/N Fee Current Y/N <br /> Address j�c� /3r.�X `3'�` �,r t �L4[ sc � �(b� � License# <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 /> Signature Registered Y/N Fee Current Y/N <br /> Address License , <br /> OTHER Company � <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# � <br /> Directions: " - • ""' •' ` • <br /> Fill out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signea 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 ii bt�ned from Property T� �(http:dappraiser.pascogov.com) <br /> 1 <br />