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. a�3aso-oozo City ofZephyrhillsFire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit T 21 �.1 S 0401 <br /> Owner's Name Z�.n,��a K���s 1=��c1 L a d h�L � 2 7 3 1 Owner's Phone Number �!� � 7 g'L �6O♦ <br /> Owner'sAddress `$s� k7�tiF �2�sHO, Za�Myati���� �'� 33539 <br /> Fee Simple Titleholder Name Titleholder Phone Number � �� C� <br /> Fee Simple Titleholder Address <br /> JobAddress �'$�� W+Rk �o�v0, ZK/�Ny/tHrc�S r� �3s3g �ot# �� <br /> Sub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑ r y emi � er <br /> Sprinkler 7�i ❑ p � B � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkier System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> 0 Other: <br /> Contractor n <br /> Signature Gft�.�. /C. �- . , .N,.-. „_. . ._ Company W5G . �s �C7�eN,Ss4Wtk LLC <br /> Registered Y/N Fee Curcent Y/N <br /> Address �Clrq ito .� / tvn,t, aq p rL 33770 License# f7,� `� b�o/Zeo � <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL Company <br /> Signature Registered Y/f� Fee Current Y/N <br /> Address License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directions:' � �. �. .>._.... .... _V_ u._. � _. _. .�.. , .. .. . <br /> Fill out application completely <br /> Owner&Contrector sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Suppiy iwo(2)sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:!/appreiser.pascogov.com) <br />