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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 <br /> Owners Name' -�S/✓�� S�/}rD d A Owner's Phone Number <br /> Owners Address - 2J / 11l�1)f✓ <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address / !� <br /> Job Address � G, l 3 4 Lot# F <br /> Sub Division Parcel# <br /> BT_ ED-�FR NL-eR EERTY A.-. i•E —� <br /> 'Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> 5a 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 '2 r <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale (Jt <br /> EDFire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> Qtri-yj rS—em—ij Anl Other <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ Sparklers <br /> Hood Cleaning ❑� ❑ ❑ � � Sprinkler System Installations Y <br /> �Hood Suppression El ❑ ❑ ElStandpipes(Sprinkler Sys) C i <br /> Fire Alarm Installation � Torch Roofing/Tar Kettle ��� ��Fire Pumps Waste Tire Storage ANNUAL n, <br /> Flammable Application-ANNUAL ? d e ® Valuation of Project <br /> Fuel Tanks <br /> 0 Other: <br /> Contractor ' <br /> Company <br /> Signature Registered Y/N Fee Current I Y/N <br /> Address License# O OaO 31 aj <br /> ELECTRICIAN /10�r /)V t^ Company TowLfeC7��ta ���icL <br /> Signature 4� p !' /5 > Registered Y/N Fee Current <br /> Address I Y10 /' License# C[- 3 0 o Z 03 <br /> PLUMBER I 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 <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 />