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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 . <br /> • <br /> Permit Application _ _ . <br /> Date Received �_ - Phone Contact for Permit <br /> Owner's Name Sr, i o >1 Rk c) Owners Phone Number (n /3 7Ye) 1 X6 7 3 <br /> Owner's Address L A C 4 13 ( r \ 1 1 0A <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address - ,r(W _ 1 / Lot # <br /> Sub Division Parcel # ' —/5 ] / 0/D r OD O <br /> .. ,,,,,,.,<,. ..::•. .«.'?'.,: »i« �;". xr ;# "� ,"...,, .-= ,,,,".,, .:y °_�" " ,, .. ,. :.ra". -..,. . °" . t. 6ir`fine? ` ,„,��ro`` ° ..> ",z„ , .s.....:.r. > - '+..«.',..- : 'd <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I - 1 Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw 1 LP /Natural Gas - Installation <br /> I - I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale f <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL' <br /> !Lamy' IemiI WW1 other / n + <br /> Sprinkler I ❑ ❑ ❑ I 1 Recreational Bum (./# / <br /> Fire Alarm N ❑ ❑ y I I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I 1 I Sprinkler System Installa ns <br /> Hood Suppression E ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) - - <br /> I — I Fire Alarm Installation 1 Torch Roofing/Tar Kettle <br /> I-I Fire Pumps IT Waste Tire Storage ANNUAL <br /> • <br /> Fire Works <br /> 7 Flammable Application- ANNUAL 1 ( Valuation of Project <br /> I - I Fuel Tanks <br /> El Other: I I <br /> ss �:$`.x� b>- .';kY•ro�s xs.''x `x.: ¢.;.,': aztz,az -a.^ ' °a» ± '"`":.'tv:f".f�.rav "° ,:w.: . `"`c...'�...§%` -Z`v's <br /> Contractor 1 Company 5 Farrt I � <br /> Signature 1, Al ,�.� Registered Y / N Fee Current Y / N ' <br /> Address IrDWEII =MTAT 1re S License # E F - vd0 ic9(4 I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered , Y / N I Fee Current I Y / N J <br /> Address I 1 License # I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address j 1 License # I 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 (http: / /appraiser.pascogov.com) <br />