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813-780-0020 Clty ofZephyrhills'Fi�e Fax-813-780-0021 <br /> . . Permit Application <br /> late Received �� O��O� /� a�.� Phone Contact for Pertnit j��^ .Sy,J 93S/ <br /> ��u��:�+�:����:.�;r�,.�........,..�.. _...� ���.�� --�-s�,���___-.-���s-•t__.° - - .��._.>,.,...._..._.�,_ <br /> )wner's Name L�S/C.-(�O ��(/�T'T/ Owners Phone Number [ �13 S�S • /3SI <br /> lwners Address �Q� UOx �� �('� /�i �� J�V �� _ � <br /> ee Simple Titleholder Name Titleholder Phone Number [� � C� <br /> ee Simple Titleholder Address <br /> ����.."'�-"-'rr''.y`.�''_�t��"��#s„"=.,.�''x.::c.u-'° -�a,�-.°"�'".a:.�'--�..� - ..'�"'�--�� --- - ��"�'���=-'�O"-'�-�-=--:�``'�: <br /> ob Address 3a� �aRN� G��� ��/�/ / v�/(.1� ��Y� Lot�' � <br /> �ub Division Parcel# �— <br /> ����- <br /> aBio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or FZQ Faciliiy)ANNUAL <br /> � Contrvlled Bum � Hood InstallaGon <br /> � Emergency Generator<30 kw " a LP/Natural Gas-Installation <br /> �qency Generator>30 kw a LP/Natural Gas-ANNUAL Sale <br /> •ction Maintenance-ANNUAL a Places of Assembly-ANNUAL <br /> r y emi AL"nT� er <br /> aprinkler � O ❑ ❑ a Recreational Bum <br /> Fi�e Alartn n O ❑ ❑ � � 5parklers �� <br /> r=� �� <br /> Hood Cleaning u ❑ � ❑ � � Sprinkler System Installafions 2 <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Atarm Instailation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Sto�age ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL \/a�U2fi0f1 Of PfOJOCf <br /> � Fuel Tanks <br /> � Other: <br /> ��• �,���. �- �,�,.��.�;�� A�,�.�•r,� ---� °°' <br /> �onUactor � S�/- Company Q <br /> Signature � �'�`� Registered l�/I�l Fee Currenl Y/N <br /> Address License# � <br /> ELECTRICIAN Company <br /> 5ignature Registered Y/N Fee Current Y/N <br /> Address License# � <br /> P�UMBEf2 Company <br /> Signature Registe2d Y/N Fee Current Y/N <br /> Address Lice�se# 1 <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# � <br /> OTHER Company <br /> Signature Registered Y!N Fee CuRent Y/N <br /> Address License# �— —� <br /> ° � -�a� ..�r_.....,.�. --- -- - a.e��} <br /> Direcdons: <br /> Fill out application completely. <br /> Owner&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 b50D0) <br /> Supply Mro(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 />