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" 813-780-0020 City of Zephyrhills-Fir$• Fax-sisaso-oo2i
<br /> Permit Applicafion _
<br /> Date Received �� Phone Coritact for Permit
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<br /> Owners Name ANDERSON PRE Owners Phone Number �� � ��
<br /> Owner's Address 51QLr ��
<br /> Fee Simple TiUeholder Name Tttleholder Phone Number � � �
<br /> Fee Simple Titleholder Address
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<br /> Job Address GOLDEN CORRAL 685 5 GALL BLVD. Z���� — F Lot# �
<br /> Sub Division Parael#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Instaliation
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation f /,, � !
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL S �� w /
<br /> � Fire Prntection Maintenance-ANNUAL � Places of Assembly-ANNUA
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<br /> Sprinkier � ❑ ❑ ❑ � � Recreationai Bum �.0
<br /> Fire Alarm � p ❑ p � � Sparklers
<br /> Hood Cleaning � � ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ O � � Standpipes(Sprinkler Sys)
<br /> � Fire Alartn Instaliation � Toroh Roofing/Tar Kettle
<br /> Fire Pumps � Waste Tire Storege ANNUAL
<br /> Fire Works
<br /> Flammable Appiication-ANNUAL � Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
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<br /> CoMractor Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address ucense#
<br /> ELECTRICIAN Company
<br /> Si9nature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Curreni 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 CurreM Y/N
<br /> Address License#
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<br /> Directions:
<br /> Fill out application completely.
<br /> Owner&Contrador sign back of appiication,notarized(Or,copy of signed corrtract 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 documetrtation
<br /> Allow'10-14 days for review after submittai date. Parcel#-obiained from Property Tax Notice(httpJ/appraiser.pascogov.com)
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