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813-780-0020 City of Zephyrhills Fire - Fax-813-780-0021 <br /> ,---- Permit Application L . ,,- ------- <br /> Date Received 1 t ry i <br /> Phone Contact for Perm 1 / / 1 WAN <br /> Owner's Name 1 \) e r∎ ? I Owner's Phone Number I I I I I I <br /> Owner's Address I 3 a so g A • Av . C Y'` r� A.�\ t- 1 3 q .sqa I <br /> Titleholder Fee Simple Name Titleholder Phone Number 1 1 1 1 1 <br /> Fee Simple Tdleholder Address ( I <br /> Job Address I Lot # <br /> Sub Division I I Parcel # I I <br /> a Bio"Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> p Comm Exhaust Kitchen Hood/Duct Hood Installation <br /> El Controlled Bum [J LP/Natural Gas - Installation <br /> Emergency Generator < 30 kw ri LP/Natural Gas - ANNUAL Sale <br /> Emergency Generator > 30 kw of Assembly-ANNUAL <br /> Fire Protection Maintenance - ANNUAL n Recreational Bum <br /> 1 i i u L'AMMI E3 <br /> `5 p e Sprinkler L j ❑ ❑ ❑ 0 Sparklers <br /> 1. 5 p . Fire Alarm ID ❑ ❑ ❑ 1 1 a Sprinkler System Installations ln� <br /> V I / <br /> L` - 1- — 0 ® Hood Cleaning El ❑ ❑ ❑ I , [j Standpipes (Sprinkler Sys) I / " <br /> `' Suppression ID ❑ X ❑ ' 1 Torch Roofing/Tar Kettle <br /> 10 per^ <br /> Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> Valuation of Project <br /> Fuel Tank <br /> 0 Other: I <br /> • <br /> Contractor / Company I <br /> Signature /j/ Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> 1 License it 1 <br /> ELECTRICIAN any I <br /> Signature Registered I Y/ N _I Fee Current I Y/ N I <br /> Address ( f License It 1 <br /> PLUMBER I any ' <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address ` License* ` <br /> I <br /> MECHANICAL I Company <br /> Signature Registered I Y/ N 1 Fee Current I Y/ NI I <br /> Address I 1 License # 1 <br /> OTHER I Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I 1 License # I <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of appficaiion, 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 witty applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpi /appraiser.pascogov.com) <br />