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- 8 13 -780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name t i r T -r /G ,,,,......5--e-/- <br /> v.,S' - ems S / r Owner's Phone Number ) y'/3 7813 z> <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address , �.,x.: „$ 3 V 6 ''- / ( /6 / Lot # <br /> Sub Division Parcel # <br /> € se <br /> n Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I -- 1 Controlled Bum I I Hood Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I - I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale ,--'- <br /> n Fire Protection Maintenance - ANNUAL nI Places of Assembly- ANNUAL <br /> ILttrlyl ISemil Ma Other • (j(1°' <br /> Sprinkler n ❑ ❑ ❑ I Recl Bumn ❑ ❑ ❑ I I Sparklers <br /> Hood Cleaning rj NV ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression n 12 I: ❑ I 1 1 1 Standpipes (Sprinkler Sys) <br /> D ✓ <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps II Waste Tire Storage ANNUA <br /> 1 Fire <br /> n Fire Works <br /> I I Flammable Application- ANNUAL ` - I Valuation of Project <br /> I Fuel Tanks <br /> F-7 Other: I I <br /> vvj,n1.�, n.,. . _.. „,_.. `: «.w, -,2' i ._. ::% :' "�M>.4 :°1f241., TAIESa�:.. nna :: :.<i'.m .,. .... �.,d. as su.... '.a. x..... v: ffa&j:_M.K:.._...06i i. ....._ '': . o-. <br /> :.u. <br /> Contractor •7` 9.....---- �� ��� —��- Company A "-� 'l G /C�,- 4.1' . <br /> Signature �—� 'er Registered Y / N Fee Current Y / N <br /> Address I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y / N Fee Current I Y / N ,I <br /> Address I 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current Y / N I <br /> Address [ License # I I <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 />