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a��-7�o-ao2o City of Zephyrhills�Fire� Fax-8i3-78o-oD21
<br /> Permit Application '
<br /> �ate Received —� - Phone Contact for P ���� r"—�T�
<br /> .��.s.:._:...v�c�c:���.,..,....�.�.._.,..�..� - ,�..�..�,�,.�.,.... ermit L._
<br /> �.'����w• ��+��•.-'.:.—a:�-1 --,.
<br /> 3wners Name m � D ;�/ ��� r�� r�
<br /> H pwner's Phone Number ��LL.LJ �X U i
<br /> �w�er'sAddress �� � (,7 � ,�.'' •
<br /> =ee Simpls Titleholder Name Titleholder Phone Number � � �
<br /> =ee Simple"fitleholder Address
<br /> ��M'-.�r.�'��i�.,.��'�.mT.v�e��,�:�z
<br /> exs°"s+s��$ �::. u��3Gi'�����{3U7.-'a�'r.^�?'.`ti^��.:ic'�.}"'.'ti�
<br /> Ja6 Addr=ss � �
<br /> Lot#
<br /> Sub Oivision � l ;y s''/
<br /> �:�=�rs'�'Tss��c-._-'�^°�.,�t;��=�;� _ Parcel# �1 -�L "� �' C��l Cl • U� �t'� (lU�Q
<br /> a � . �°"'w'°""°� �r�k�.'�52"�..i .�r.et, da� �G' ,.�..,c,--_..�...,3�..,,.-�u
<br /> Bio-Hazard Waste 5lorage-ANNUAL a Fumigatlon Tent
<br /> � Comm Exhaust K3tchen HoodlDuct � Hazardous Materia!(Tier li or RQ Faclliiy}ANNUAL
<br /> � ConVolled 8um � Hood Installatlon
<br /> � Emergenoy Generator<30 kw � LP/Natural Gas-Instal�ation
<br /> Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> Fire Proteotion Main2enance-ANNUAL a Places of Assembly-ANNUAL
<br /> ❑�r'�y em� �n er Q �
<br /> Sprinkler ❑ p p Recreational Bum t 'I 71C{�
<br /> Fire Alartn p p � � Li U �
<br /> � [� ❑ spa►�e�
<br /> Hood Cleaning O ❑ ❑ Sprinkler System Installa8ons
<br /> Hood Suppression � ❑ ❑ ❑ �� � Standpipes(Sprinkler Sys)
<br /> aFire Alartn InstallaU�n � Torch Roofing(far Kettle
<br /> Fire Pumps � Waste Tire 5totage ANNUAL
<br /> Fire Works
<br /> Flammable Applicatlon-ANNUAL Valuation of Project
<br /> Fue(Tanks
<br /> Q Other:
<br /> �.��� -
<br /> Contractor3 .�_.,_x,.��,,,3,.,�,_.__.��,�.;,����-_������."7�,
<br /> Comparry " �-•�. , .� ,cr � '3tit _ ''' fe
<br /> Signature ' Registered Y N Fee Current N �
<br /> Address � �c �]� , -� -
<br /> ► � '�'��° License# ;��, i i}
<br /> ELECTRICIAN
<br /> Company
<br /> 5ignature Registered Y/N Fee Current Y/N
<br /> Address ��
<br /> License#
<br /> PLUMBER Company —�—
<br /> Signeture
<br /> Reg"tstared Y!N Fee Current Y/N
<br /> Address
<br /> llcense#
<br /> MECHANICAL
<br /> Company
<br /> Signature Registered Y/N Fee Current Y/N �
<br /> Address
<br /> Licensa#
<br /> OTHER � _
<br /> Signature
<br /> Company
<br /> Registared Y/N Fee Current Y I N
<br /> Address
<br /> r.�-�- ��..,.-�.�.��-�.-�::�:�,.<,���_:��.�„• Licensa#
<br /> Directions: ---�:�..,�..�.�.,s,,...,:,_.=,R.,,R�s.,.,�,�s���
<br /> Fill out application corriplstely. � ^�� ��+�Y�-��`��'
<br /> Owner 8,Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> If over 52500,a Notice of Commencement is required(Mechanical work over 350U0)
<br /> Supply two{2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for r�visw after submittal date. Parcel#-obtained from Property Tax Notice htt _!/a
<br /> ( p' ppraiser.pascogov.com)
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