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s�3aaaoo2o City of Zephyrhills-Firs• FaX-s�aaso-oo2� <br /> Pertnit App(ication <br /> Date Received � <br /> , • �,_�=�.�0..... . , .�^ . ,y _ Phone Contact for Permit M�,�_��� <br /> ._ ..��s.;�c�.�°�-w�;�:�:�-�:.,—�s�zc.�a^.:��-���.. �.� �� _ <br /> Ovmers Name ANDERSON PRES Owner's Phone Number � � � <br /> Owner's Address 51QLF M(JgRAY <br /> Fee Simple Titleholder Name TiHeholder Phone Number C� C� � <br /> Fee Simple Titleholder Address <br /> � .-M:�.�<- ,;, ",���=�c <br /> . <br /> ... ..>.. . _ r . <br /> . .....z x. .s_ ....,y.....,._ ._.._.. ... ..,__. _. s.: < >�': °�l��°,+R�'.. .a, z.� ,."�n".;:��'� �.s�s���'�.`:4�:<<'�:.__;:`�'�'-��.;a::,�' <br /> Job Address GOLDEN CORR.AL 6855 GAI,L BLVD. Z���n,� — Lot# �� <br /> Sub Division Par�el# <br /> _ --�>�---�:.,,,... ..:��� �� .�, �• - :�_�.u.���wa�'���tas�:.:��•°�r - <br /> .;_...:..< ��;.�::���=-�r.:��;�N-.-,£�-, <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm F�chaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Eme►gency Generator<30 kw � LPMatural Gas-Installadon t� <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale , � �Z�v <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL r� <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreationai Bum <br /> Fire Atarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ p � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alartn Installation � Torch RoofinglTar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Appiica6on-ANNUAL Valuation af Project <br /> Fuel Tanks <br /> Q Other: <br /> .:_<_::�:`.�..."�r^°'K ----r,.�_�_�:� ���ia�i.�b< .__ .:� ,ti=i ..�� <br /> Contractor <br /> Comparty <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <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 <br /> License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER <br /> Company <br /> S'9^ature Registerad Y/N Fee Current Y/N <br /> Address License# <br /> , _ ,m. . ..,,�.. .z � . .. . ... -ti36_nY��._—�..._:.....,.. <br /> . . '_"_�_. , � „ <br /> D�rections: _ _ �:.-.;.:..::�;.�- .�_,�.� ..�.,�,...:.�.�.: - ° <br /> Fill out application completety. <br /> Owner 8 Cotrhactor sign back of application,notarized(Or,copy of signed contract wfth ovmer) <br /> If over$2500,a Notice of Commencemetrt is required(Mechanical work over$5000] <br /> Supply two(2)sets of drawings wifh applicable documerrtation <br /> Ailow'10.14 days for review after submittai date. Parcel#-obtained from Property Tax Notice(htlpJ/appraiser.pascogov.com) <br />