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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 `Z vs !P 1 7 T3 <br /> Owner's Name Owner s Phone Number / d oL-- t T r/ <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phons'Number <br /> Fee Sim pia Titleholder Addresses J <br /> Job Address 10 IS t{ -- Lot# <br /> Sub Division. Parcel# <br /> op <br /> o • Bio-Hazard Waste Storage-ANNUAL Furnlgafion Tent <br /> Comm;EXhaust Kitchen,Hccd/Duct Hazardous Material(Ter it or RQ Facility)ANNUAL <br /> QControlled Bum Hood Installation V <br /> Emergency Generator<30 kw LPINatural Gas-Installatior Emergency Generatoro 30 kw LP%Natural Gas-ANNUAL Sate <br /> ❑ Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> © me-M-11® o er <br /> Sprinkler ❑ D D ❑ Recreational Bum <br /> Fire Alarm H <br /> ❑ q ❑ spa rklers <br /> Hood Cleaning o ❑ ❑ D ❑ Sprinker System Installations , <br /> od Suppression ❑ ❑ ❑ Standpipes(Sprinkler Sys) <br /> 21 Fire:Alatm Installation Torch Roofing/Tar Kettle <br /> . Fire Pumps a Waste Tire`Storag.e ANNUAL <br /> R <br /> Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> ❑ Other, :.:. <br /> Contractof Company t-tr G' 77,574 <br /> Signature "' - Registered /N Fee Current Y/N <br /> Address License# d M,4 17 <br /> ELECTRICIANJ Company <br /> Signature Registered 'Y/N Fee Current <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 <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$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(http://appraiser.pascogov.com) <br />