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s��-7ao-aoza <br /> City of Zephyrhills�Firs� Fax-813-78o-oa21 <br /> Permit Application <br /> - Phona Contact for Permit �,�,�m� <br /> )ate Received '� ".."'"""'�� �•��� - <br /> :�.'.S�Z.+-'cR.".�:&AC�7Cdt�h'"���>e.�.»w�.�,....w..�..� - ^ � + � � <br /> ' pwne�'s Phone Mumber <br /> hvners Name ^ <br /> �wners Address � � �� h � � ( � (/ t' /� ) <br /> Titleholder Phone Number t_.G.L.L� �d a vJ+ � � <br /> =ee Simple'riUeholder Name <br /> =ee Simple Tideholder Address ce��'"k:'.j.�'�"'� ^''�-'� <br /> ��'�� <br /> �. Lat# <br /> Jo6Address ��.�� ,�/ �GVao '�v��b _ �i �6 <br /> Parcel# <br /> Sub Division ;�,-z�,,;�-����'_.�.�..�.��°__�,.,��.a�Y <br /> �'�'�'""`�" � FumigaUon Tent <br /> a SiaHazard Waste 5torage-ANNIlAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardcus Materiat(Tter li or RQ Facilify)ANNUAL <br /> � ConVolled Bum � Hood Installatlon <br /> � Emergency Generator<30 kw � LPINaturel Gas-Instalia6an <br /> Emergeney Genarator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> Fire ProtecUon Mairdanance-ANNUAL Q Places of Assembly-ANNUAL 2��� <br /> ❑�rT�y emi � er Q � I_f <br /> 5prinkler ❑ O O Recreationai Bum � <br /> Fire Alarm O ❑ }�l Sparklers <br /> � �� a Sprinkler System installations <br /> Hood Cleaning � � � � <br /> Hood Suppression � O 0 ❑ � a Standpipes(Sprinkier Sys) <br /> � Fire Alarm Installation � Torcfi Raoftng(Car KetUe <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works ' � <br /> Flammable AppiicaUon-ANNUAL. Valuafi.loft Of PI'ojeCt <br /> Fue1 Tanks <br /> Q Other: .����.�� <br /> �� � <br /> Comparry ' � '�• = •i� 'ir� - �. <br /> ConVactvr - <br /> Signature ' Registered Y N Fee Current Y <br /> Address � 1� a - � i '' ('' License# J V i� <br /> ELECTRICIAN Company <br /> 5ignature Registered Y/N Fee Current Y/N <br /> Address License# � <br /> PLUMBER Company <br /> Signature Registered �(/�1 Fee Curtent Y/N <br /> Address Licensa# � <br /> MECHANiCAL Company -- <br /> Signature Registered Y 1 N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> Registered Y/N Fee Curreni Y(N <br /> 5ignature � <br /> Address License# � <br /> ,��7",n*.]F'3"i'S�r.a..`.+ - .r.�' _ - —.u� <br /> _-.,�u.ur.u..:��d�.�7r�=� _�,,.. � -�l:3'���*ulE�: <br /> �fBCt10f15: <br /> Fill aut applicaUon oampletaly. <br /> Owner&Contractor sign back of applicatior�,notarizad(Or,aopy of slgned contract with ownar} <br /> If over$2500,a Notioe of Commencemant is required(Mechanicai work over 55000) . <br /> Suppiy two(2)sets of drawings with appiicable dacumentation <br /> Allow 10-14 days for review after suhmittal date. Parcel#-obtained from Property Tax Notice(http:l/appraiser.pascogov.cam) <br />