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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit 3_ <br /> Owner's Name hCelLA "i"\ C1 cL1021tt Pt,✓,-I' Owner's Phone Number <br /> Owner's Address 3'7 7 3 - l 11.'.'V- <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address c/ / <br /> Job Address / 7-3S L' g,"c XU Lot# <br /> Sub Division Parcel# <br /> OBTAINED-EROM_P.ROP_ERT-T-XNOTLC-E-------+ <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-Installatior <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> M@ Semi Anl Other <br /> Sprinkler ❑ ❑ ❑ Recreational Burn �f 0033 <br /> Fire Alarm ❑ ❑ ❑ Sparklers v <br /> Hood Cleaning ❑ ❑ ❑ El Sprinkler System Installations <br /> Hood Suppression Standpipes(Sprinkler Sys) Gf CV' <br /> Fire Alarm Installation Torch Roofin /Tar Kettle <br /> C� 0 g <br /> Fire Pumps W/aaste Tire Storage ANNUAL <br /> Flammable Application-ANNUAL 13 Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor' Company CG wlC 5 c S <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 /> 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 />