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1 <br /> x <br /> 81.3-780-0020 City of Zephyrhills-Fire Fax-813-780-0021 <br /> Permit Application-late Received Phone Contact for Permit I I ` <br /> I <br /> _ - -I, , z - y -. __r �.-._ ,...-Zr S- ..- <br /> f <br /> )wners Name % ' 11 _ 11 i( ci, } _ 2 -`'/1 Owner's Phone Number t r ",) 1-1-4 t t .fie -:°. - r -- IL.a 4 i 1-i j 1�.(.�; \' J <br /> )wner s Address -,•- .i ...i ,�:='k i f1__ 1 t� i v„,--t„;.. <br /> :ee Simple T itleholdei Name Titleholder Phone Number [ f <br /> ;es Simple Titleholder Address I <br /> W -- 7MEWILMa IEWr,- + `I T.iti 'St-r+rfgo3 -,cam. E)1_ <br /> <� ' .7 � ~� L 4:)‘- C' _ , ',.,.t, r l�, t `-a t ( Lot# <br /> Job Address y r <br /> Sub Division ( s1 ail '7�// ' �#'�;`�C� Parcel# ti . % ': i� ,.;_t,'/,--1 .' tI / . <br /> '7raE>FR ��I-r -3.ri;'ur'a- _.see., .,,.,....zz... .».: <br /> n Bio-Hazard Waste Storage-ANNUAL I ` Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material(Tier ii or RQ Facility)ANNUAL <br /> nControlled Bum n Hood Installation <br /> nEmergency Generator<30 kw LP/Natural Gas-Installation <br /> Emergency Generator>30 kw n LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL r---1 <br /> Places of Assembly-ANNUAL <br /> r y (Semi I IAni I Other <br /> Sprinkler 1 1 ❑ ❑ ❑ I ( Recreational Bum <br /> Fire Alarm E ❑ ❑ }�1 ( 1 Sparklers <br /> Hood Cleaning ❑ 0 /❑ Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I 1 Standpipes(Sprinkler Sys) <br /> n Fire Alarm Installation I!I Torch RoofinglTar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works • <br /> Flammable Application-ANNUAL ' Valuation of Project <br /> Fuel Tanks <br /> Other: I <br /> ---' ",' :,4.., -3^- ,_.-.::�'. .,E y14ck.aew4?.'_c+-1,1:1 :.r, a ^.h'.E.rz.. WI.._ E }L7-..c <br /> Contractor Company 1!►►'`t <br /> 4- ,cam ' '; t"a _ 11c, <br /> Signature rx _ .- Registered luau Fee Current Ml <br /> Address 3 .({ a :. - ---3 r 7ic. License# E v. i6 Z.)ii.. ►0+.1 to, <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current ( Y/N ,, <br /> Address , I License# I I <br /> PLUMBER i Company R <br /> Signature I Registered Y/N Fee Current Y/N <br /> Address 1 License# I <br /> MECHANICAL Company <br /> Signature Registered Y I N I Fee Current I Y l N <br /> Address License# <br /> OTHER Company ' <br /> Signature Registered Y/N Fee Current Y/N - <br /> 1,...... Address Lee# <br /> .s— :- ...� �,�Y.a .. ...., _,-.�.::..: i,• r. <br /> Directions: <br /> Fill out application completely. <br /> Owner&Contractor 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 55000) <br /> Supply two(2)sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:/lappraiser.pascogov.com) <br />