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813 - 780 - 0020 City of Zephyrhills Fire CO _tV Fax - 813 - 780 - 0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit 112 7 I I g q 2 I I I g q • <br /> Owner's Name 61 • 1 s ae Owner's Phone Number I 1 1 I <br /> Owner's Address 1 116 Y C 4/ rer 5 <br /> Fee Simple Titleholder Name I I I I <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address t / � e � / (' I <br /> • e ' s 33, y� Lot # <br /> Sub Division <br /> Parcel # <br /> I I Bio- Hazard Waste Storage - ANNUAL I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> I Controlled Burn n LP /Natural Gas - Installation <br /> n 1 Emergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I Emergency Generator > 30 kw n Places of Assembly - ANNUAL <br /> XI Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> (Qtrlyl 'Semi Anl Other <br /> Sprinkler 0 ❑ ❑ n Sparklers <br /> Fire Alarm © ❑ ❑ ) I I I I Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ I I 1 1 Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ I l n Torch Roofing/Tar Kettle <br /> n F ire Alarm Installation n Waste Tire Storage ANNUAL <br /> n F - ire Pumps <br /> n Fire Works <br /> F Flammable Application- ANNUAL <br /> 1 Valuation of Project <br /> n Fuel Tanks <br /> F O ther: I <br /> Contractor <br /> Company I A T 4- 1 So (u 4 1 on . tnC. I <br /> I <br /> Signature Registered Y/ N j Fee Current Y/ N <br /> Address 1 35 31 liney,}p RBI, <br /> 1 License# I Er0000 I <br /> ELECTRICIAN I <br /> Company <br /> Signature Registered I Y / N J Fee Current I Y/ N <br /> Address I <br /> I License # I <br /> PLUMBER Company <br /> Signature Registered I Y/ N I Fee Current 1 Y / N I <br /> Address I License # 1 <br /> MECHANICAL Company <br /> Signature Registered I Y/ N j Fee Current I Y / N <br /> Address 1 I License # 1 <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address 1 I License # I I <br /> 1 <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 />