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813-780-0020 City of Zephyrhills "Fire. Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received <br /> 7 / Z 0 0' Phone Contact for Permit <br /> , <br /> Owner's Name L'tS 2i- tZ lT Owner's Phone Number 8 �� ..s g3S1 <br /> Owner's Address PO BIM 'Me '1M L 33C74. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> Jiad4's:1�- :3; > >rs -:,. 7 - .,s j� �^ ems l . .'.A. 1 � / fi n <br /> Job Address Ui�6 611 - RDG /t/ ,S7/8 G f L L 1S LIJJ'_ Lot <br /> Sub Division <br /> Parcel # <br /> Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> Ti Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I Places of Assembly - ANNUAL <br /> IUtnyl Isemi) FT Other <br /> Sprinkler E ❑ ❑ ❑ I 1 Recreational Bum <br /> Fire Alarm I I ❑ ❑ ❑ I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ <br /> IL 7�/ <br /> ���� Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I Fire Pumps I Waste Tire Storage ANNUAL <br /> 1 l Fire Works <br /> 7 Flammable Application- ANNUAL ( Valuation of Project <br /> I ( Fuel Tanks <br /> 1 I Other: I <br /> Contractor C Y /� Company /LLR dearam <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I ( License # I I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address 1 I License # I <br /> PLUMBER I Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address 1 I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y/ N 1 <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address 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 />