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81�-780-OG20 Ciry of Zephyrhills rir:e Fax-813-780-OC21
<br /> - �. Permit Application
<br /> Dace Received I� � `� �'� ph
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<br /> one Contact for Pertnit �
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<br /> Owner's Name n��t�n)r `r � �JuLUT �C Owner's Phone Number �� C� ��
<br /> Owner's Address (��_ S - — _ JC�C+� � _, D 3
<br /> ree Simole Titleholder Name Titleholder Phona Number � � �
<br /> Fee SimpleTitlehold=rAddress
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<br /> Job Address � 3 � ��--��..) P �� '� �
<br /> Lot r
<br /> Sub Diwsion
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<br /> Parcel� ��rJ�
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<br /> Bio-Hazard Waste Siorege-ANNUAL � Fumiaation Tent
<br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> Controlled Bum � Hood Instaltaiion
<br /> � Emergency Generetor<30 kw � LPlNaturai Gas-Installation ��/" 3��'/
<br /> � Emergency G=nerator>30 kw � LP/IVat�ral Gas-ANNUAL Sale �
<br /> n Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> `'r-' ny emi ni ner ❑
<br /> Sprinkler � ❑ ❑ RecreaUonal Bum
<br /> Fire Alarm � O G �. � � Sparklers
<br /> Hood Cleanmg � u ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � G ❑ ❑ �� � Standpipes(Sprinkler Sys)
<br /> � Fire Alartn fnstallation � Torch RoofinglTar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL �� Valuation of Project
<br /> � Fuel Tanks
<br /> � Other
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<br /> Contractor _... . ..u.... _ _u .. ���'.3.`_ Zn:.:..ssry'z`x , �._�.E:�:..'.:�f?iY:�i9.:��A�.:�`ri:t^.'�`r'?"s`al.s:?;°.nd�r:�'w.
<br /> Company
<br /> Signature Registered Y 1 N Fee Current Y/N
<br /> Address
<br /> License#
<br /> ELECTRICIAN
<br /> Company
<br /> Sigrature Registered Y/N Fee Current Y/N
<br /> Address
<br /> License#
<br /> PLUNiBER Company
<br /> Signature Registered Y/N Fee Curtent Y�N I
<br /> Address
<br /> Licensa#
<br /> McCHANICAL Company
<br /> Signature Registered Y/N 'ree Current Y/N
<br /> Address License�
<br /> OTH�R ����_ Company , �I� �r2C� � YL�T Lr�� T,uC
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<br /> Si nature L-�_�� Registered I �/N Fee Current Y/N
<br /> Address a( � -
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<br /> icense .
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<br /> irecfions: - - • =
<br /> Fiil out appiicaiion completely .._. ,_.�_.�..._,.u..�..: ...... ....<_...,. .._�,. . .,... ----- .-.
<br /> Owner 8 Contractor sign back of aoplication,notarized(Or,copy of signed contract with owner)
<br /> li over�250U,2 Notic=o:`Commencement is required(Mechanical work over W 5000)
<br /> Suppiy two(2)sets of drawing=_with appiicable documenta[ion
<br /> Aliow 1 C-1�days for roview after submittal date Paroel r-obtamed from Property Tax Notice(httpJ/appraise;.pascogov.com)
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