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813-780-0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit I 1 <br /> Owner's Name ✓ F/ y k 2- 8t✓U/A Owner's Phone Number <br /> Owner's Address t' 56 / Q / Y 1/Q /,L ( jJ�\ <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address L,. J / y 0 6. /31,(/) 7 /UNaQ. y Ho ) CS Lot # <br /> Sub Division Parcel # <br /> I I Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> 1C I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I .1 Hood Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> Iutrlyl 'Semi' Fig Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning I-1 ❑ 1 n Sprinkler System Installations <br /> Hood Suppression D ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I I Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ( Valuation of Project <br /> I I Fuel Tanks <br /> Other: I <br /> r_r..... <br /> Contractor �� , <br /> Company k' N t-� �' H CA./ <br /> Signature �/ L G p(� (pop Registered Y/ N I Fee Current I Y/ N <br /> Address I f License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address I License # ( I <br /> MECHANICAL Company <br /> Signature Registered Y / N J Fee Current 1 Y / N <br /> Address 1 I License # I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y N _I <br /> Address 1 License # 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 />