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813 - 780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> . Permit Application <br /> • <br /> Date Received I Phone Contact for Permit <br /> 1 <br /> Owner's Name 2- f / / / / f, ' / /�f ( '17 y �r4 (7,,,,,,5e_ Owner's Phone Number <br /> 3 �a`10 <br /> Owner's Address ". , ,1v6 2e, . 1 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ..., . .,. , ; w .. w 1 ..... 'mm..n._w mopava, a, 1ff - *: ,.ti;g:tE ...iva... .. „�•; .,.. .,. ,�,4 .. .,. ... .s, > ,,..„ ,A <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> ri Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent � � � <br /> I Comm Exhaust Kitchen Hood /Duct r----] Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw I] LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> I Otriy l 'Semi) J fl Other <br /> Sprinkler ( ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I ( I Sprinkler System Installations <br /> Hood Suppression 71 ❑ X ❑ I I 7 Standpipes (Sprinkler Sys) <br /> 7 Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> PI Fire Pumps I Waste Tire Storage ANNUAL <br /> 7 Fire Works <br /> Ti Flammable Application- ANNUAL I Valuation of Project <br /> I Fuel Tanks <br /> ri Other: I <br /> ,., M_.:-,_1.:: : . : :C m. ... .^a ,.H,A,au...,a AIMV.'?.9 x.. ,ar..N,a..,....5.. ZSIEId :,#'a"MUES,: ti <br /> Contractor Company <br /> Signature Registered Y / N 1 Fee Current Y / N I <br /> Address l I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current Y / N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N ]I <br /> Address I I License # I <br /> OTHER <br /> Company <br /> Signature s-r- - Registered FQ Fee Current ' N <br /> Address l License �Z" <br /> i se# <br /> Directions: <br /> on s <br /> s iz.�G l <br /> Directions: _._ ... .. . _........�.. e.,�s.�.. -:. <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 />