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F ."� <br /> 3-780-OD20 City of Zephyrhills Fire Fax-913-7e0-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> • <br /> Owner's Name PAs�a U��- ANC 'cU Owner's Phone Number L� <br /> Owner's Address 1Fi Cr A U- bLV_D " <br /> Fee Simple Titleholder Name J Titleholder Phone Number �..�. <br /> Fee Simple Titleholder Address <br /> Job Address V:& v r A t^ rJ LV Lot# <br /> Sub Division. Parcel <br /> . BiorHazard Waste Storage'-ANNUAL Fumigation Tent <br /> 0 Comm:-Exhaust Kitchen Hood%Duct � Hazardous Material(Tier II or RO Facility)ANNUAL <br /> Controlled Bum Hood'lnstallation <br /> Emergency Generator<30 kw LP/Natural Gas-Installatior <br /> Emergency Generator>30 kw LP/Natural Gat-ANNUAL Sale <br /> El Fire Protection Maintenance L.ANNUAL ED Places of Assembly-ANNUAL 6qlt® emi M] err <br /> Sprinkler Ei p ❑ ❑ B Recreational Bum ice, <br /> Fire Alarm Cl ❑ ❑, ❑ F Sparklers 1 <br /> Hood Cleaning El ❑ ❑ ❑ F� Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation Torch Roofing/Tar Kettle <br /> 0 Fire Pumps Waste Tire'Sforage ANNUAL <br /> 8 Flammable Application-ANNUAL Valuation of Project <br /> FUel Tanks <br /> Q Otlier: , <br /> Contractor Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> ELECTRICIAN 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 iFL ZJr AZo `M(=(y-/ DJN%QTCZ 'FUS,& -b Company <br /> Signature Registered I Y/N Fee Current Y TN- <br /> Address \ y1-1 T r= LA 'FL 33�1 _J License# rL. \\1 <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,Ibock 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 />