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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application /I <br /> Date Received F Phone Contact for Permit <br /> Owners Name C-(Z t' t°L VF i' y� 't`i p� �/Owner's Phone Num <br /> Owner Address ber <br /> 's F�.� r/ - - Z_;i 1 � LL ":5L` 33 s <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address J6 A-V C 4 .L Gr ►'Ll LL Sry Q Lot# <br /> Sub Division Parcel# <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 /> 0 Emergency Generator<30 kw LP/Natural Gas-Instailator <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sate <br /> Fire Protection Maintenance-ANNUAL E-1 Places of Assembly-ANNUAL <br /> PRO We-m—, er <br /> Sprinkler ❑ ❑ 0 ® Recreational Burn <br /> Fire Alarm ❑ ❑ ❑ Sparklers <br /> Hood Cleaning ❑ ❑ ❑ Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation Torch Roofing/Tar K <br /> Fire Pumps WasteXoe Storage ANNUAL <br /> R <br /> Flammable Application-ANNUAL nation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor Company /p.^ G �i 1t;C��c ry t K � <br /> Signature C Registered g N J Fee Current I MI N <br /> Address License# �0_` "g <br /> ELECTRICIANJ Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> MECHANICAL Company _ <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> OTHER Company <br /> Signature Registered I Y/N Fee Current Y/N <br /> Address License# <br /> Directions: _ f <br /> Fitt 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$50001, <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(hftp:flapprelser.pascogov.com) <br />