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s \ <br /> �8�3aso-oozo City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application . <br /> Date Receive� ' � —� Phone Contac.t for Permit � � � <br /> Owner's Name r �.i Yj`,�, {� �,(' �! L((j7C/ Owners Phone Number ��� � �U� <br /> Owner's Address 0�/� �!'�'ls�L`1"� �,1- do`� '�10�d <br /> Fee Simple Titieholder Name � . Tiileholder Phone Number � � � <br /> --r'C S:f��;':�;.t{e!':C4:r3�:�:tire�s �-- — �--- ----- - -- -- '- - � -_ ----- - - --- --- — - - - - -- --� - <br /> JobAddress . - �j�(r, 1"J1�� �G� C��}'}1S � �` ,�U(���,� ^ ������ `Lot# � <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 <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LPMatural Gas-ANNUAL Sale <br /> � FireProtectionnAain;anance-Af�PP:A! - -- �-Pl�ce�ofAssembly-�;�!p7U�:�---- `��-j�''j-.00�--- - --- - - <br /> t y emi �n er <br /> 5prinkler � � O ❑ ❑ B � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �r1�� j� �� <br /> T� <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppressfon � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fusl Tanks <br />_ Q Other: - <br /> Contractor /� !. ,��� Company :-,-. , <br /> Signature 0 /�'i�-/v Regfstered 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/(� Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Regfstered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> Signeture Registered Y 1 N Fee Current Y/N <br /> Address License# <br /> Directions: <br /> Filf out application completely. <br /> avner&ConVactor sign back of application,notarized(Or,copy of signed ConVact 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 /> - � __ Aliow 10.14 days for review after submittal date. Parcel#-obtalned from.Property Tax Notice(http://appraiser.pascogov.com) ' <br /> t-_ __ . <br />