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813-780-0020 , , _ , City of Zephyrhills Fire / Fax-813-780-0021 <br />' ' ' Permit Application J l�p— S�jZ� <br /> Date Received J 1� i Phone Contact for Permit 35� -� / `7 <br /> ___._____...._._.._.....�_._..__.�_._.......___.__...._...__._..._..._._._.___..�. <br /> _ ..._ . ____...._._�.__ ..._���..._ _.�_. _.... ____._,._.._ _.._.._..._.._._._._,._.__a,.,_ ._.,�.__ <br /> Owner's Name � , _ �� �lf � � ^ ��L.• Owner's Phone Number � � � <br /> Owner's Address �. , i' �E� _ {�'\�i,, L' � �j �' `� (� � f <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � � <br /> I Fee Simple Titleholder Address � � II <br /> w,..,.___._. .�.. _. .._.._._.�.. .._. .,._._.�__. .�._.._ ..___.. <br /> ...�_..�_ ..__. _.�_.,_ <br /> . ,..-_ „ _ �_.. .�..,-:--__ <br /> _,.. _ .._ <br /> ,_... _.... . _. _, ._.... .�....., __ .�. �. ,... ,...:o.. . ..�..-.� <br />, JobAddressT{ N�_�._�. �� �,a i ��.• ��� �Lot# Y� <br /> Sub Division Parcel# <br /> �_ _. _..._..., ... .... __ .. __ __�..�.. ._..�. __._. . .w _..._ _. _.,--..,e, .< ., - <br /> • _. ..�. •., _._,:�a_.v......__ -_ _..e.w _ � <br /> . . _...__�..�. _.�.�_._.__ _._�_ _. . _ _.__ _. . �,._.. _a..._.._ ...__. _. _ ..�> _ - , --. - - - .. ._ � �._.... _ � <br /> � Bio-Haz Storage-ANNUAL � Fumigation Tent <br /> omm Exhaust Kitchen Hood/Duc � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> ontrolled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LPlNatural Gas-Installatior <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> Qtr Semi An Other <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> � Standpipes(Sprinkler Sys) � V I ��� <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> ��:.,..�....�.�..�,..� ....�_ _„_. . __._..,_.._ ._._��._ ____�_._ .�. ._.___._.�..� ..._..�_.. .____�._..._ _._. - __ �..�_._:_.� <br /> i Contractor Company � ��� <br /> .r - <br /> Signature 1 �� - Registered Y/N Fee Current Y/N <br /> I Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature " Registered Y/f� 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 /> 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 /> \ <br /> i <br />