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817-780-0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application , <br /> late Received - Phone Contact for Permit <br /> )wner's Name / . to 10'Na Yl y .S S • Owner's Phone Number \ <br /> )wner's Address lo 3 -t L?' `\ a \ 0 A.. f 1 r iyi (Is Fl 3 3 S LI c,- <br /> 'ee Simple Titleholder Name i Titleholder Phone Number 1 21/ 3 17v 74Q7 <br /> =ee Simple Titleholder Address <br /> e -" F. .,. a. nrJ ;! -b. a :fir _. .. ...... r. ., .. 1 ._.... i:i: .,.: t,. ,,. ... : d : ,- - .�:��:...:...�� <br /> s <br /> Job Address 1 62 329 64 ( / i J Lot# <br /> Sub Division I I Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL Fumigation Tent <br /> El Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw Ei LP /Natural Gas - Installation <br /> ED Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Are Protection Maintenance - ANNUAL a Places of Assembly ANNUAL <br /> '+ mi (al tither <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ p/ ! I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ 1 I ID Sprinkler System installations <br /> Hood Suppression D ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch_ Roofing/Tar Kettle <br /> EM <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works • <br /> Flammable Application- ANNUAL <br /> 1 , Valuation of Project <br /> Fuel Tanks <br /> El Other: <br /> Contractor n (� Company � [)/7/ = <br /> Signature Il i _ \ ) Registered O.X. Registered jIMI t Fee Current Waal <br /> Address 91 N E Gil f 1 License # I - F . t MO 1 Q9(' I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fe Current Y / N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered --- / N Fee Current Y / N <br /> Address I 1 License # 1 <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N j <br /> Addr Address license # <br /> ess rr�,'a a 1.1„,, _ _ . _.- ° ,,.r , ,esc;��,..a..:...:,.s.. eZ <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 />