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813-780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 7 . Phone Contact for Permit <br /> Owner's Name I 7)/ / &C S A ' / 5 7 1- 4 - "Z r Owners Phone Number 1 9 ) 3 1 1 7 / S . 1 1 70 72 <br /> Owners Address 1 3 '1 4 �� 5 11 -4 - /` <br /> Fee Simple Titleholder Name Titleholder Phone Number I <br /> Fee Simple Titleholder 1 I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> q <br /> n Bio- Hazard,Waste Storage - ANNUAL = Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 0 or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw • n LP /Natural Gas - ANNUAL Sale <br /> ® Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Litd J 'Semi' Lad Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning IT ❑ ❑ . ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression I I ❑ X ❑ 1 I n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> Fire Pumps . n Wdste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 5 `12- I Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor iin', ! �rd Company //Gi Arai., "" ,� — c <br /> Signature / Registered rgEll Fee Current n ilyx s <br /> Address lea • / 0.4 z ,e 23 J eM I , Q R lam--- 3377X) License # ) 5 / c o I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N J Fee Current I Y/ N <br /> Address 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 I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address License # <br /> - _... ��,.�,-- � --�.<. .,�.- -,_.s e ��a -:• ��,. <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 />