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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Recei;,�d Phone Contact for Permit��,�_� I, <br /> �3�'-":C..:. <br /> Owner's Name �:"��� Z C ✓�-e 7 y.}r 5 Owner's Phone Number � � 3 � ��j �V I� <br /> �Owner's Address � 3� � ��� I� 1 U t�• ��Q h ( h . ��S F � , � S�( 2 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> �'s"`,,.�.'°��,`...�_.�._.., - - - - __..,..zw.�..�...-"p'°'.P.:�..�a..�-`� <br /> Job Address s �� <br /> Lot# <br /> Sub Division Parcel# <br /> �.`W-.,'°� - .__...<_...,.._.....�._..��___.��.,_-...�..._....,.��...��...�<.�.....�.�.��-- _...,_,..._ _.._....,.����.��...__.�___._.._..__.4._.._.�..�... <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 /> tr y emi �n t er <br /> Sprinkler � ❑ ❑ � � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler 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 /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: ' <br /> :�_°w-�..- r_.,..�� ...__.�...a.M_,.Y�_._._._.,._�..���.T.�.�____. _�..�._.A..�....v._� —�:.�.�_�__�.,�._��_....�___:_,,:,..�_�__m...,_._..�� <br /> ,�JContractor ,�/� �� �� `� � Company <br /> f�\Signature U ��y�"� /�vr'�""Y ` Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature 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 1 N Fee CuRent Y/N <br /> Address ' License# <br />', ru...--.��.�..._.._.a____._..,�...,»....._...__..�:._._..�._.,.#�_..__-u.._..�__.�..........__�_:_.,._...�..�.__._�._.�.....,.�......,n._._._.a.-.e�.n�.__._„_._.,�_-:..,.._._„__...:._b_.�a�,�_...._.._N.._�_e.,�,�-�..,_...�;:� <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 Nolice(http://appraiser.pascogov.com) <br />