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813-780-0020 City of Zephyrhills Fire a 1 0 Fax-813-780-0021 <br /> Permit Application "(�� <br /> Date Received Phone Contact for Permit �J <br /> Owner's Name Owner's Phone Number <br /> Owner's Address ve L�a 1 cJ " UL, <br /> Fee Simple Titleholder Name ,l1. Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address a op Gf;,f � vG• Lot# <br /> Sub Division Parcel# /Y�J ea <br /> ,EIRIYae AX GftU <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 Q LP/Natural Gas-Installatior <br /> o Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sale <br /> 0 Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> 5t Semi An Other <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ 1� Sparklers <br /> Hood Cleaning ❑ ❑ ❑ t� Sprinkler System Installations y -/ <br /> / Y <br /> Hood Suppression � ❑ ❑ ❑ EJ Standpipes(Sprinkler Sys) <br /> Fj Fire Alarm Installation Torch Roofinglrar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> R <br /> Flammable Applicafion-ANNUAL (AZ(/Ox l/�� Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor /L_ -�, Company Gr✓4frr^c /�: /cc lac. <br /> Signature Registered Y/N Fee Current Y/N <br /> Address ' �"� F. ✓�2. 0' VN�r�rc o �7J1 I y License# Q <br /> ELECTRICIAN Company e r �_... — ��✓,c(y <br /> Signature Registered Y/ Fee Current Y/N <br /> Address H wry License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current <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 />