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I <br /> 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 �i <br /> Permit Application ' <br /> Date Received Phone Contact for Permit � I 3 _� �5o a I <br /> Owner's Name I � ��J`t 5 Owner's Phone Number �p�� �-�'`l o �S� 1 I <br /> Owner's Address ���� �(_ ��, ()C�J� 3�o�-� <br /> Fee Simple Titleholder Name � �,�,�..L, Titleholder Phone Number l0 �s �'t�`C� 'I�� 1 <br /> Fee Simple Titleholder Address � Q � v f�L�1 YL�i. Lc'0� �' C�C7� . T ����__ <br /> — �, ^ - - - ---- -- - - — - - <br /> :a <br /> Job Address 3 l (�.M. ��V� �e {'l.i.'�S � 3�s�( Lot# � I <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 Burn � Hood Installation L� .�t�3 <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation ,�` <br /> � EmergencyGenerator>30 kw �LP/Natural Gas-ANNUAL Sale 3p5o.00 <br />� � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL , . <br /> try emi �n t er �P ���(�1�'�' <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn ��� <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers ( �� uv v C"���-___'-� <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations f� i� / /� <br /> �7 `U <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) /��V <br /> t <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle q <br /> � Fire Pumps � Waste Tire Storage ANNUAL �p�li� I <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> 0 Other: <br /> IContractor Company <br /> Signature Registered - Y/ Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature I Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# - <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> � � <br /> _.. . _ . - - - <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$5000) <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://appraiser.pascogov.com) <br /> I'�t��l 8�'� <br />