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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 <br /> Owner's Name 12e0i/ API' friS U LE' NhQ .GLe - I owners Phone Number I gJ 11779' (I 72r6 <br /> Owner's Address I Y 4/S /5/20R7 /CDm0 -7ed Gtr/ ('.-s 3 Z- I <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 I <br /> Fee Simple Titleholder Address I I <br /> Job Address 1 I Lot # I I <br /> Sub Division I I Parcel 1 I .2‘-2)- 0" '61 a) I <br /> Bio-Hazard Waste Storage - ANNUAL El Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct I Hood Installation <br /> Controlled Bum n LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw El LP /Natural Gas - ANNUAL Sale <br /> ED Emergency Generator> 30 kw Places of Assembly-ANNUAL <br /> El Fire Protection Maintenance - ANNUAL 1= Recreational Bum <br /> ® ELM 0/1 MEM <br /> Sprinkler E ❑ ❑ ❑ = Sparklers <br /> Fire Alarm CI ❑ ❑ ❑ I 1 [ Sprinkler System Installations <br /> Hood Cleaning = ❑ ❑ ❑ l I J Standpipes (Sprinkler Sys) <br /> Hood Suppression E ❑ ❑ ❑ l I E] Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation = Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> 0 Other: I/7 l <br /> Contractor �� ■■ Company <br /> Signature Registered Y/ N j Fee Current I Y / N <br /> Address I I License # <br /> ELECTRICIAN Company I <br /> • <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address License # <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 /> • <br />