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813-780-0020 <br /> City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> ate Received h V m s Phone Contact for Pertnit <br />� � � N K��a�nJ � ^;i�i� -�8 R Owner's Phone Number ��3 �$Z"' ��,� <br /> nnmer's Name ,1�+�' ,M 1/�t <br /> Nvner's Address ^� 0 �� r sr s �� <br /> ee Simple Titleholder Name <br /> Titleholder Phone Number <br /> ee Simple Titleholder Address <br /> ���z u���'w::��--,,.:..�.��_. �m <br /> _ , - �;�w,:+;'�.x_,.:k�: �ro�d&?�--�rSe:,�zz°�'�:�. �^e:�°4:a'"`�a - �� <br /> Lot# <br /> lob Address <br /> Parcel# <br /> iub Division > , g , , . . , x -_ .,_ .�«,�:�:����.� <br />. �+w ""�+C . ... .ro-:fi`. ..> x 4v..�, iCYkv"=r:.\ ='a:.-��^A'.s ...-fi"^ . .fi . fi'.. ... �+3wy: . a.m x. � _ <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Conirolled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LPlNatural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑� emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ � L� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ��� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofingffar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Ta�ks <br /> Q Other: , <br />�,, ,:. ,, _���.,._;����....,�,..;,...,: _ ��,�:�;M - _�:�*,.:��: <br /> Contractor Company pll �1M��IG� r/�kt'fRFEj ►9JL. <br /> Signature 0'�-' Registered Y/N Fee Current Y/N <br /> Address 3�p CK�u�y �v�. � I.PrXr�AN�1 �z 33�)1 License# ,�012 �coece'Z <br /> ELECTRICIAN Company <br /> Signature <br /> Registered Y 1 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 /> ¢ - <br /> Directions: <br /> Fill out application completely <br /> Owner 8 Contractor sig�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://appraiser.pascogov.com) <br />