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a�3aao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application � <br /> Date Received � — <br /> _�_ �� , Phone Contact for Permit ��� <br /> �-"—��.�.____�._ <br /> Owners Name G�T @�% �(� �(/LC.S` Owners Phone Number � (�� � <br /> u <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address � <br /> Job Address O l�2 � �• ��"Ll R-f�i� - ��-- /3 S "�� , � <br /> Lot# <br /> Sub Division Parcel# <br /> 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 /> Sprinkler t ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � �'���Y�, <br /> � � ❑ l� <br /> Hood Cleaning 0 ❑ ❑ Sprinkler System Installations � � <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � �� <br /> ;� Fire Alarm Installation � `•� <br /> � Torch Roofingffar Kettle <br /> �� Fire Pumps � Waste Tire Storage ANNUAL <br /> � ;� Flammable Application-ANNUAL V81U2t1Of1 Of PfOJ2Ct <br /> � ;� Fuel Tanks ^ e <br /> Other: <br /> ��!/� <br /> �.�--_ --�-------..-^ <br /> � - - -- - - - _.__ <br /> - Contractor _ _ Company � c�/ZI <br /> Signature Registered Y/N Fee Current Y/N <br /> Address' � . C3wF1,/E�[,(�,/ 6'• 6 l o <br /> � License# /S <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/fv <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 <br /> ,__� License# <br /> OTHER + <br /> , Company <br /> Signature _ Registered Y/N Fee Current Y/N <br /> � <br /> Addr ss `��Sp � j�_ ory/a' L 3cFZ7J License# <br /> �,c � �__..�w � . .. . - .. .. . i Z <br /> . � � <br /> •- - , . - —_. <br /> Directions: � 1- - - .......��- �-��---..,_----s <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 />