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813 -780 -0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> Permit Application _ -. <br /> Date Received Phone Conrad for Permit I <br /> Owners Name I , �:1(//e - S.Itilie , ' .1,r-A----4,,..i vim:. 4 I Owner's Phone Number ( e 1 1 ' 2F -2 - I U - <br /> Owners Address 1S j ,-,7 r ,7 — < .7d cf,-A, /% , - <br /> Fee Simple Titleholder Name I / I Titleholder Phone Number 1 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address I Lot # I <br /> Sub Division I I Parcel # I <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> 0 Comm Exhaust Kitchen Hood/Duct ED Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> 0 Controlled Bum n Hood Installation <br /> Q Emergency Generator < 30 kw n LP/Natural Gas Installation <br /> CI Emergency Generator > 30 kw n LP/Natural Gas - ANNUAL Sale <br /> 0 Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ® �® • :. <br /> Sprinkler Li ❑ ❑ ❑ n Recreational Burn <br /> Fire Alarm n ❑ ❑ ❑ I I fl Sparlders <br /> Hood Cleaning ® ❑ or ❑ I I n Sprinkler System Installations <br /> Hood Suppression 2 ❑ jQ ❑ I I n Standpipes (Sprinkler Sys) <br /> 0 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> • Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ' I Valuation of Project <br /> Fuel Tanks <br /> Q Other. I I <br /> Contractor Company <br /> Signature Registered Y/ N , j Fee Current I Y / N I <br /> Address I I License* I I <br /> ELECTRICIAN' Company I <br /> Signature Registered Y/ N j Fee Current 1 Y/ N j <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N 1 Fee Current I Y/ N j <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N j Fee Current I Y/ N j <br /> Address I 1 License # I I <br /> OTHER Company L <br /> Signature Y Registered Fee Current <br /> Address 1!�MINP j s / License # ♦ e coo ( • <br /> �.,aez era „-•., .. ma _. _.._ ,_ „neae. -. a. r„ :, .3 ..•w` <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 />