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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application ` 2 <br /> Date Received Phone Contact for Permit <br /> Owner's Name 6h1 L /- C Owner's Phone Number <br /> Owner's Address a k / Sm af iT— sA vt,a <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address p /I' <br /> Job Address C�l /¢''�� �L6�'✓', (i£ /L /G`L �' Lot# <br /> Sub Division Parcel# D'7" -.' -2 —6000—00/60— Q <br /> 77_ (OBTAINE—FROM:P-ROP_ERT_Y.TAX:N Off ICE) - - <br /> FJ 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-Installatior <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> rotection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> Qtrl Semi An <br /> Sprinkler � ❑ ❑ Recreational Bum 1 <br /> Fire Alarm El <br /> ❑ ❑ ❑ ers <br /> Hood Cleaning ❑ ❑ ❑ ti ll t I t Sprinkler System Installations <br /> p y �V <br /> Hood Suppression ❑ ❑ ❑ ipes prinkler Sys) <br /> Fire Alarm Installation Torch Roofing/Tar Kettle v <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Flammable Application-ANNUAL (D 00 Valuation of Project <br /> Fuel Tanks <br /> Other: ��✓fTi6 >/L �-I a LEA" ��`' /�G :'YI�/ji c.4' o /C G <br /> Contractor Company C/ //LLB <br /> Signature Registered N i Fee Current Y/N <br /> Address ut f �741 4I 1 License# $ O�"��Z®CP <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 J Fee Current <br /> Address License# <br /> OTHER Company <br /> Signature Registered I 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 />