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813 -780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received • I Phone Contact for Permit <br /> �Dwner's Name 1 ' 1 • 1 .727– . 7 .r • )�L :. -, ;.\ I I I I . I <br /> 6"6:311 ' (� ' 1 Owners Phone Number <br /> ( "'Owner's Address !J •.�' ( V, 3 -+., j':• 2 1 .7 , ,• 1 / .; r L `! - 3 �' ; . <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> J ob Address G ay 6.(1 rs1vj,� icy i 2c,;�,� G,,1lS re_ j3Sy Lot# <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum n Hood Installation <br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I I P /Natural Ga -a ■ _ -le <br /> n Fire Protection Maintenance - ANNUAL .` Places of Assembly-AN, - • <br /> ILtrlyl !Semi' Uther <br /> Sprinkler ❑ ❑ ❑ - Recreational Bum <br /> Fire Alarm I ❑ • ❑ ❑ I I n Sparklers <br /> Hood Cleaning I ❑ • ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression n ❑ • ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> 7 Fire Alarm Installation TI Torch Roofing/Tar Kettle <br /> I] Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> I Flammable Application- ANNUAL I I Valuation of Project <br /> F - 7 Fuel Tanks <br /> Other: I <br /> tractor .. � . �.... �.. , ...�. ��.�. ....��.,.w.: <br /> /el Company I <br /> ' <br /> Signature ,may D v .Y,. Registered Y / N 1 Fee Current 1 Y / N I <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current I Y / N j <br /> Address I <br /> I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 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 />