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0 1 a- f ou-uuzu <br />City of Zephyrhills Fire <br />Fax-813-780-0021 <br />Permit Application <br />Date Received <br />Phone Contact for Permit <br />Owner's Name <br />LE� <br />Owner's Phone Number <br />Owners Address <br />Fee Simple Titleholder Name <br />Titleholder Phone Number <br />Fee Simple Titleholder Address <br />Job Address <br />614 r- A eq Lot # <br />Sub Division <br />Parcel <br /># <br />0lcita -:t1i LL( <br />B Waste Storage -ANNUAL <br />Fumigation Tent <br />Comm Exhaust Kitchen Hood/Duct <br />Hazardous Material (Tier 11 or <br />RQ Facility) ANNUAL <br />Controlled Burn <br />Hood Installation <br />Emergency Generator < 30 kw <br />LP/Natural Gas -Installation <br />Emergency Generator > 30 kw <br />LP/Natural Gas -ANNUAL Sale <br />Fire Protection Maintenance - ANNUAL <br />MtTe_r__1 <br />Places of Assembly -ANNUAL <br />FDTrTyl Fe—m-1 P 7n <br />Sprinkler F-1 0 0 0 <br />F-1 <br />Recreational Burn <br />4 <br />Fire Alarm El <br />ID 0 <br />El <br />Sparklers <br />Hood Cleaning 0 <br />0 0 <br />Sprinkler System Installations <br />Hood Suppression El Di <br />0 0 <br />F1 <br />Standpipes (Sprinkler Sys) <br />Fire Alarm Installation <br />Torch Roofing/Tar Kettle <br />Fire Pumps <br />Waste Tire Storage ANNUAL <br />Flammable Application- ANNUAL <br />2 S700 <br />Valuation of Project <br />Fuel Tanks <br />Other: <br />Contractor <br />I <br />4 A� 4irq <br />­� ry <br />Company <br />y <br />Signature <br />Registered I J,� N <br />Fee Current Y/N <br />Address <br />License # <br />ELECTRICIANI <br />Company <br />Signature <br />Registered Y/N <br />Fee Curnimt <br />Address <br />License # E_ <br />PLUMBER <br />Company I <br />Signature <br />Registered I Y/N <br />Fee Current Y/N <br />Address <br />License # F_ <br />MECHANICALI <br />Company I <br />Signature <br />Registered Y/N <br />Fee CLirrent Y/N <br />Address <br />License # <br />OTHER <br />Company <br />Signature <br />Registered Y/N <br />Fee Current Y / N <br />Address <br />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 />