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813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received /' --a too <br /> Owner's Name e <br /> / Phone Contact for Permit <br /> e .�l �� Owner's Phone Number 2f3 /60Z3 <br /> Owner's Address 38 Z z��iy ,-4 /is , <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ... .... n. r. )a .n. , F E0. :F'("4. .. f .` ' ,1t,a: " r W M.,. ...+. -{ ,, ..., . {, r Cr. ....e <br /> Job Address <br /> Lot* <br /> Sub Division Parcel # <br /> ri Bio Hazard Waste Storage .. w� 4 _. . . :: _. ,.:. : . _,�, .W_ .,., . ....... . .. . . . .. <br /> e - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> FT Controlled Bum n Hood Installation <br /> I - 7 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Ti Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> l Utnyl Item) FE11 other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning ❑ iii ❑ I ( I Sprinkler System Installations <br /> Hood Suppression .:, ❑ Af ❑ I 1 I 1 Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I I <br /> Fire Pumps I Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> I <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> El Fuel Tanks <br /> I I Other: 1 <br /> u..._..:i .....«s G.. LE s. ..:.. m.., ... ;,,,,& • M4W :: :, 1%:..xs.3 ..2AVZAWNemet ...i..Rita u,�K , ., _ __t „,,,.. _. mavva,z,,zre,:;,,, <......, 21; .. ., . _ <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N I <br /> Address ( <br /> 1 License # <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I <br /> License* <br /> MECHANICAL Company <br /> Signature Registered Y / N j Fee Current I Y / N <br /> Address I <br /> License # <br /> OTHER Company G <br /> Signature P �CG� 4(.vt�t_ Registered DV`� Fee Current LIj'r� <br /> Address b , s License # I - SO Z 5 -� (a( e, j t <br /> D Directions: <br /> .,....:.� ....,. <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 />