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813-780-0020 City of Zephyrhills Fire Fax-813-780-002� <br /> Permit Appliption <br /> _�::tc Rece�ved � o� <br /> _: _ ..__.3�=:. : _• ---. .�°���-�.;.r=�=:�;�=�:..::•-�-�:�u�..�_.,�-.�;;;�e_ _�, - - <br /> Cor�iYact tor Permit '�.�"� 9y 2 i q q 3 � <br /> :�wner'sName ��C� —L�T /}$�0 ��'PY!!G�/ w.is _ . ���3�.. ___._....__...__.-:.�:��:.�_-_. -.-.: . <br /> o�s Pr,«�N��� ��3 780 6�z.� <br /> �,�:-^t�saddte� 3730/ CfhtP,E[. GCL Loo� z—f�lLLS GL 33Sy� � <br /> "ee Simple Titleh0ldet Name I�� � <br /> Titlehoider Phone Number � � 1 ; <br /> �+�S�mpie TittehOltler Atld�ss �-- <br /> -�.3:- __�_,-�'r�c�."�� � <br /> � ��r�==1,.._: .: - <br /> Job Address �� <br /> LOt# <br /> aub Drvision <br /> , -_ :.._..._..,_,_ <br /> _ ...,��-:::�_.z--_�:,.��-._.-__....,..,.._ � <br /> --- -----� •.��,��.. �r.�...:,. <br /> --b..,��- ��—--=- _ __-- <br /> � BiaHazard 1Maste Staage-ANNUAL � Hazardous Materiei ` --- l=--=_- - - <br /> ❑ (Tier p or RQ FaCility)ANNUAL <br /> Comm Exhaust Kitehen Nood/puct � ������� <br /> � Controlled Bum � �prry�q�������n <br /> � Emergency Generator<30 kw _.. � tPMBtr�ral Gas-AMNUAL Sale <br /> � Emergency Generatpr>3p 1an � PlaCes of Assembly-ANNUAL <br /> � Fire Protection MaiMertance_ANNUAL ,,,,_--------- - - <br /> � �� � Recreatlonal Bum �'., <br /> Sprinkler a � � � � ❑ <br /> Fire Alarm 5��� � <br /> � � � � � � Sprinider Sysfern in�taUati � <br /> Hood Cleaning ❑ a � � Q <br /> Stendpipes(Sprinicler 5ys) ��'"� <br /> Hooc Suppressi0n Q .❑ � � Q <br /> � 'torCh ROOfingflar Ketne <br /> Fire Alarm Ins(allation o <br /> � ��T�Storage ANNUAI <br /> Fire Pumps <br /> Fire Wprks <br /> � Flammable Application•ANNUAL � <br /> Fue1 Tanks Vatuation of Project <br /> ❑ Other: <br /> _. -_,_�,. <br /> ._.�,,..�.,.,: . <br /> . - ""' 1 <br /> �onUactor ...;�;c�.i�:�.�___._. - <br /> S�gnature Cpnlpany . 1 � 'O n <br /> nddress 3 c,,��� y�e �9�e�ed Y/N Fee Current Y!N <br /> n� ucenea� <br /> :-�tCTRICIAN F O� �(/ <br /> �iynature COmpd�ly <br /> address R°g'�°+�d �,�Y 1,N � Fee Current Y/N — <br /> _��utitaER L�Cense# �— <br /> ��y natu r e Cp�7��Y � <br /> �dc�PSS R��� Y/N Fee Current Y/N <br /> ��'•Ft.NANICAL ��# � <br /> �,ai�.,!we �mPa�Y <br /> Aodress Re9isterod Y/lV Fee Cunant Y/N <br /> �T�{E-I� � LJCC�IS@7� <br /> anaturE �m <br /> Pe�Y <br /> Fddress Re9'��ed Y r N Fee Cuaent Y/N <br /> _. <br /> -. --.-:=-:�-„_�_ <br /> �r�-�aons ' --- --� �t1aQ# <br /> -__ <br /> --'..�._,t�-,���x-�. -'- <br /> �.v::..- ''_== <br /> F�q oui apptiqtion cpmpletCly ' . �,�_Y._;,.:c:.•-c,.�_:__._,-...__; <br /> Owner&Contraccor sign badc of aPP��apon.notarized(pr,c�pY of signed contr����) ' <br /> �+over s2soo.a Not;ce pt����nt������'���000) <br /> SuPaY Mro(2)Sets ot drawinqs wlfh e�p�dpq���n <br /> AHow 1 o-�a days tor review att�subna�!da�ee. <br /> Parcel#-obtained from ProPertY T8x No�Ce(http:l/appraiser.pasCOgov.com) <br />