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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received y' • .� � Phone Contact for Permit � � �J�7 70 <br /> Owners Name f � � J _ _. - - -- Owners Phone Numbe� __ .�(�___ _._(Z._._---- �j�_ . <br /> Owner's Address ���J� 2L�/�1� S <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simpie Titleholder Address <br /> , - ----._._� _ _ — --------.--.-----_-_—.______.�._�____._.�_--�--------..r_�._.. _v__`.._L,_w._�_.____.�_—_.-----__.._._.��.--•---- -=—._ e.. <br /> Job Address Lot# � <br /> Sub Division Parcel# <br /> -�--_. . .__ --- --------__.__...—.�_. ,._�,.y - -- -- ---- - - - <br /> �__..�.__...._,�_ _._._._.._....-°-- ----r---- -._.__.,�.._._..___,_ __-.___�-__---�--_.�._._ .__..�--_----- __..�__ -_---- ---_----._»-----....._..._...._�....r-- -� <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 /> t y emi �n t er �: <br /> ❑ � � C�`�ns-� p,�, �>e�,P,�- <br /> Sprinkler ❑ ❑ ❑ Recreational Bum 1 <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 /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> �� --�-- -------------- _�___--_ _-.__--z__e____,.,___,.�-.» - - - - -- — - - <br /> _ .-_ _�_,�.- - ---�- — - -_.._�_ ...___����. .. .��__�-_.�..a..._ _------�. ..------^—'-----�a...__.J.�_..A_._._�__�. �.....�____._---_._��_3 <br /> Contractor Company <br /> Signature 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/N Fee Current Y/N <br /> Address License# <br /> f�'"'..._..__._.�. <br /> � ._��.."' _"_""__ "_'°�,_'_'"_..'_`"__"�""._" '_"__.'�.�._.�,-_�__:..__ .._.�e_,..:__""'___�_...___ ._.._„"""'. .._" _. -v. _'°' _ <br /> —.. ,.... __._-_•._ .. . . ... _.. ._. ...__, <br /> - � . . , _ . _ .m .� ».�..__�.���_"..._'" _'_'"__' __"_� <br /> Directions: <br /> Fill out application completely. <br /> Owner 8 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 />