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813 -780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received j Phone Contact for Permit <br /> Owner's Name dd `S e Owner's Phone Number <br /> Owner's Address 3.15 9S 6 -41 /4 /1 %c: <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 I <br /> Job Address 33 /4d/ - Lot# <br /> Sub Division Parcel # <br /> F. . ,. M .. a.. s. , . m s, a. .. ,. a '.,.y WFAXIO a' . , W., . . .= v ,,,,.. 2 Z•ziAT W<;N: nom. �. .:'.: ,W U .. :.•.., _ -.�.. <br /> , .. a , m.a. , � <, , wm .. ... � . ..... gt +.: �........ <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I 1 Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I f/ Places of Assembly- ANNUAL <br /> lUtrlyl (Semi' Fir 1 Other <br /> Sprinkler n ❑ ❑ ❑ 1 Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> n Other: 1 <br /> .r :.:1efi Ea .pia. inizuMEMWism -'' sa,w k M,f.w..,.>W,2 sgE,::g.60a _. Uk,.,.,.:aAiM :iaZ,a.I saE.a' A..» ....E. a in ..,._.......e... <br /> Signature <br /> Contractor 1 ",�, r, � I Company <br /> Signature � �/ Registered Y / N j Fee Current 1 Y / N j <br /> Address I I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current 1 Y / N, <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current I Y / N <br /> Address 1 I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N l Fee Current I Y/ N I <br /> Address I 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 />