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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> I� � Permit Application <br /> Date Received I it Zi -0r/ I Phone Contact for Permit I I <br /> Owner's Name I C4)40, _S4, ,' I Owner's Phone Number I I I 1 1 I <br /> Owner's Address 1 (,4l( 3). /(X 2-A <br /> Fee Simple Titleholder Nafn2 94 I I Titleholder Phone Number I 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address e l i jE t GA11 Nv 2.e Lot # <br /> Sub Division 7 / VO I Parcel # I 1 <br /> E Bio -Hazard Waste Storage - ANNUAL 0 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 0 Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> 7 Controlled Burn I5] LP /Natural Gas - Installation <br /> 0 Emergency Generator < 30 kw I] LP /Natural Gas - ANNUAL Sale <br /> II Emergency Generator > 30 kw I Places of Assembly- ANNUAL <br /> I — I Fire Protection Maintenance - ANNUAL I] Recreational Burn <br /> IQtrlyI emi Eaj Other <br /> 4!-- Sprinkler ❑ ❑ ❑ Sparklers <br /> Fire Alarm El ❑ ❑ ❑ I I 17 Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ 1 1 EI Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ I I F Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation I Waste Tire Storage ANNUAL <br /> a Fire Pumps <br /> 0 Fire Works <br /> n Flammable Application- ANNUAL 1 a, ask5", 00 1 Valuation of Project <br /> 0 Fuel anks <br /> n O /er: <br /> Contractor Company GA -1 S -I'S .tC <br /> I1- <br /> Signature k Registered Y/ N I Fee Current I Y/ N <br /> Address _ • • License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> I License # I 1 <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> 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 />