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813 -780 -0020 City of Zephyrhills Fire. Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit • / 3 Li 75 6S-6 <br /> Owner's Name I Owner's Phone Number I 1 <br /> Owners Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> ?r ^ ?: .M, <br /> Job Address 3 7s /5 -71-, h` �- �--)ell 7r rn, .44F- Lot # <br /> Sub Division Parcel # I <br /> 8> '.. v d�T ' r z• . sa= ,: ,t; ,g�,- -- as.�;n«z;' 4> <<. 4444 x,4 >,z- ns:t < ..: .Y ^c s , o:�z? -:==. K. <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> IT Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I—I Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL 9/0 �y <br /> IUtriyl !Semi1 Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ I I h Sprinkler System Installations <br /> Hood Suppression 2 ❑ Jl1 ID I n Standpipes (Sprinkler Sys) <br /> I - I Fire Alarm Installation l n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> pi Fire Works <br /> 7 Flammable Application- ANNUAL I Valuation of Project <br /> -) Fuel Tanks <br /> n Other: I <br /> Contractor Company ,, . r 4 444'4 .,.;G...: ,c , cif. :'u:::z`r n. t•,,.:6:sv <br /> Y/UG - p b/-� - Fr ' - / '-"-- Mr <br /> Signature �� Registered Y/ N j Fee Current I Y/ N I <br /> Address LI 7C4 LdG �c.rr 113 14L- - ._ t t I License # 17/5 CC%'CD,P (,o 1 <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N ] Fee Current I Y/ N I <br /> Address ( I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N J Fee Current I Y / N j <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # <br /> Directions: . W., s <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 /> • <br />