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a��-�ao-oo2o City of Zephyrhills�Fire Fax-813-780.0021 <br /> �- •.:. Permit Appiication - <br /> Date Received Phone Contact for Pertnit 7 L 7 t I S d 4-O i <br /> Owners Name Z�'-p K Y�Ft�t-4S �=�K L �-���•�i '� 2 l 3 1 Owner's Phone Number �t 3 7 8 2 46 a 4 <br /> Ownet'sAddress L a�� W+2�= I�°r+a, Znp..y4H��ci,I'� 33S 39 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � �� <br /> Fee Simple Titleholder Address <br /> JobAddress ,m�'�yl VW�Q�'_Rm~�, ���KyRL«cCS�I"L 335'i� Lot# � <br /> Sub Division Parcel� <br /> � Bio-HazardYWaste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or i2Q Facility)ANNUAL <br /> � Controlfed Bum � Hood Installa6on <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generetor>30 kw � LP/Natural Gas-ANNUAL Sale /� <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ��l9 <br /> �y emi �n er �� �/-, <br /> Sprinkler � ❑ L� �D � � Recreational Bum J <br /> Fire Alartn � rJ ❑ ❑ C� � Sparklers ,r. <br /> ^�. <br /> Hood Cleaning � O ❑ ❑ � a Sprinkler System Installations �� � ` <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Insiallation � Torch Roofingffar Kettle <br /> Fire Pumps � �Naste Tire Storege ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL �--� Valuation of Project <br /> Fuef Tanks <br /> Q Other: <br /> Contractor �/ v Company wSG ,L•�s ,tc..—�o..� S^;,�ta.cwS LLG <br /> Signature Q`� � ~ Registered Y/N Fee Current Y/N <br /> Address �� a:j�«- t..-� �%�s: L�s a� o "� 3 3 7�o License# �23 8�.7 6 c�a�Z o o t <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Currerrt Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registe�d 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 /> ..�,-.;--. ��>...._ _ <br /> �_.�..___.._ ... _�_.__.__ -_ _�.- - -� � - - - - -- - __._. _.. _ - - - - - <br /> Directions: <br /> Fill out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement ls required(Macha�ipl work over$5Q00) <br /> Supply 1wo(2)sets of drawings with applicable documerita6on <br /> Allow'10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(httpJ/appraiser.pascogov.com) <br />