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- 813- 780 -0020 City of Zephyrhills Fire <br /> Fax - 813- 780 -0021 <br /> Permit Application <br /> Date Received /r I "7 <br /> Phone t for Permit <br /> Owner's Name / Di ist F .,, j .1.44c 1 Owner's Phone Number I I I <br /> ) 11 I <br /> Owner's Address ,/r Q L 3 4 1 / <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I I I I I <br /> Fee Simple Titleholder Address I <br /> �` ,aft MMIKA '�.x�..�'.,:i, "¢* ..�. Q;;,c ox <br /> G' , � s�>�� r � , ' ��� ,4'0 �, �� .. �> ,�R „.�z om.- ,�;s�� . °,�. ; s „'� ..e3f�� F • <br /> Job Address S / 3 / ,01� 8i z.e ii.A 31rY <br /> I � � I Lot* I I <br /> Sub Division I Parcel # I <br /> F - 7 Bio -Hazard Waste Storage - ANNUAL Fumigation �W, �R,. r, ,.,..,¢ , ,e..�,4 , ,, �a w,bE ar <br /> Tent <br /> n 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 n LP /Natural Gas - Installation <br /> F Emergency Generator > 30 kw - LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL IMIKI Places of Assembly- ANNUAL / ,,' f . <br /> ) <br /> WIN El Utnyl !berm' OW other , J <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum 1:-9---47 <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> f I <br /> Hood Suppression ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> n Flammable Application- ANNUAL <br /> El Valuation of Project <br /> Fuel Tanks <br /> I Other: I <br /> Contractor I " D � Company r <br /> Signature 1 Registered Y / N Fee Current Y / N <br /> Addre s ( I License # I <br /> ELECTRICIAN I Company I <br /> Signature 11 Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER I Company <br /> Signature I Registered Y/ N - I Fee Current I Y/ N <br /> Address I 1 License # I <br /> MECHANICAL ) I Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License* <br /> OTHER I I Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I License # I <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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />