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C <br /> 813-780-0020 City of.Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date ceived Phone Contact for Permit <br /> • • er's Name A Z N2 Qu-e. Owner's Phone Number <br /> I Owner's Addres lJ t /oQ t • <br /> F eed ple Titieholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> LT,' AA =+ • ,a ' : _ _ ", -:. <br /> Job Address c j fcf Ca .r Lot <br /> Sub Division Parcel # () 2 ' U/' 2 1 " 0080 - 00 la -W Z <br /> Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> 1 I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Burn n Hood Installation <br /> 1 Emergency Generator < 30 kw I ( LP /Natural Gas - Installation <br /> 1 Emergency Generator> 30 k LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL (AI Places of Assembly- ANNUAL <br /> }Gitrly1 !Semi1 III Uther <br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ l Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation 1 1 Torch Roofing/Tar Kettle . <br /> Fire Pumps j I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 I Valuation of Project <br /> 1 — I Fuel Tanks <br /> ET Other: 1 <br /> Contractor Company <br /> Signature �� +• 41 g • Registered Y / N Fee Current 1 Y / N <br /> Address I 6 I License # 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address l I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y / N - <br /> Address I • I License# <br /> OTHER . Company <br /> Signature Registered Y / N ( Fee Current 1 Y / N <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 $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 />