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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> . a:? a Permit Application <br /> Date Received (3 2 ''- _ Phone Contact for Permit r 3 _ 3 S O I O <br /> --•---�;- ems- _-_____ - - "<""°"_""-'"_'"'_'r...F'r.'-- -- - -- - - <br /> Owners Name ' 4'•� e � t ICp /L Owner's Phone Number <br /> Owners Address y{ `3 r0" '� - S'� el <br /> Fee Simple Titleholder Name'�':..:�-.`:'.�- - .,'�� Titleholder Phone Number <br /> Fee Simple Titleholder s Addres <br /> c�-%cc•�•e-,...-a...___� s r-rid•�-'-�-1------a--..•—T--,--�-^-�-r---- - - _ _ ��-, <br /> Job Address S J 3 -1 - 3 G 6,J1 l u Lot# <br /> Sub Division L k o 2 ��� S Parcel# L l—2-6'- 2-L- 01 O-d57 0 O-O 2 D <br /> 0 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 a LP/Natural Gas-Installation <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> emi [71759 ter <br /> Sprinkler 0. 0 ❑ ❑ Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ = Sparklers <br /> Hood Cleaning ❑ ❑ ❑ Sprinkler System Installations !/ <br /> Hood Suppression El ❑ ❑ ❑ Standpipes(Sprinkler Sys) �1 <br /> Fire Alarm Installation Torch Roofing/Tar Kettle U <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor /IT^ Company <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 />