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813- 780 -0020 City of Zephyrhills Fire Fax - 813-780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit r l <br /> Owner's Name (A)Qr) (Ay Owner's Phone Number 113 1 9 '1 1 1. <br /> Owner's Address 5 I GAO e t V 4 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> ., x E . „ „nv. ,. .,, -"� a x .N #a.,<«.. .. ...,.. ,s, ,at ^rte... .... ,S N.Af>,... h' O a » > +,> 0_ .. <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I ✓I Places of Assembly- ANNUAL <br /> IUtriy� �SemiI ral Uther <br /> Sprinkler r ❑ ❑ ❑ ( I Recreational Burn <br /> Fire Alarm n ❑ ❑ ❑ 1 I 1 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> H Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I Flammable Application- ANNUAL I ( Valuation of Project <br /> I Fuel Tanks <br /> El Other: I <br /> .e.... w.._.�,. 'L. :_.0 : : ::1 ` ___>..:.J ,"z...:�.afied :,._ 1ZETAA ,''u .....M.� ,MIME aiAilf2,� e �...ti F., ,. : ..,na. .L. v 5,._. x>n...,...i: ,,,�._.�: � .._..>.x�.a, .�.:. >A <br /> Contractor Company ( <br /> 1 <br /> Signature `tea Registered Y / N 1 Fee Current I Y/ N <br /> Address I • J License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current Y/ N 1 <br /> Address I <br /> 1 License # <br /> PLUMBER Company <br /> Signature Registered Y/ N - I Fee Current I Y / N I <br /> Address I I I <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current 1 Y/ N <br /> Address ( I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current Y/ N I <br /> Address I License # <br /> Directions:...fuM....._ .. <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 />