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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> .�te Received �� o / Phone Contact for Permit b' �%I (p <br /> ._. 4, _ > �,.-�; _. -�..�>� �-�. <br /> Owner's Name � ►7�-�►— Owner's Phone Number � 'fvCJ �g <br /> Owner'sAddress �{� �G�G✓1 �� �Q,C� l.Gi-F-��0.l1 G� � ���ol <br /> Fee Simple Titleholder Name Titieholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> s,°=-: . :-�t�'°"�`�,.�F.�'��.;� .. . a m..� x, r. ,� <br /> Job Address �'$(D� �GL� � �OG�� L� h r� ��5 F� Lot# � <br /> Sub Division �(,Lbl l S�1�p r � • Cen-F�er Parcel# <br /> .. �-:-.�.f,. ��,� :,��,���::���.°�.�,�a�.��° ,� ���.��z� �.:.�°���.. � �,. .�... ,.::_��= .. x°,-�..��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-Instailation �'�r�r�• <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL t� <br /> r y emi �n er �`� <br /> Sprinkler � � ❑ ❑ B � Recreational Burn � <br /> Fire Alarm � ❑ � ❑ � � Sparklers / 5� <br /> l� <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations f 3�` <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) l <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL ry � , �b Valuation of Project <br /> � Fuel Tanks <br /> Other: 1re S r�, er S S�c ry�oc and acict � -E-0 4 ►re S r�� erS <br /> .�-- ,.����-_��� . �:�:. , : f �. �• .�rs.�.�,<�-�.=y. ..,�. � . � <br /> Contractor _. Company 1 n C 1 �� SVL. <br /> Signature ��- Registered 1�/ Fee Current Y/N <br /> Address License# D3 l OOOo'2o'10 O <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 /> . . .. . . . .. . t��� . <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 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:l/appraiser.pascogov.com) <br />