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City of.ZephyrhillsFir•.e• Fax - 313-780 -0021 <br /> 3 0020 Permit Application <br /> 1 Phone Contact for Permit <br /> Date Received I <br /> e ers ' • � umber <br /> Owners Name <br /> Owner's Address I 3( "C ' l l ) 1 --k-r r 3 1 <br /> Titleholder Phone Number ( (l <br /> Fee Simple Titleholder Name <br /> Fee Simple - titleholder Address I . ' Ga. t, _Y. ..w_. and. <br /> Job Address <br /> ✓S �C `3- -O 1 CISJ,0 Lot # <br /> 1 Parcel # <br /> Sub Division <br /> v <br /> n Bio-Hazard Waste Storage - ANNUAL = Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El -Controlled Bum n Hood Installation <br /> 7 Emergency Generator < 30 kw <br /> n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw <br /> LP/ tural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> cm semi) (� �OUrer <br /> ❑ Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm pi ❑ ❑ ❑ I I 1 1 Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ I ( I ( Sprinkler System Installations <br /> Hood Suppression = ❑ ❑ ❑ 1 ( II Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation Torch Roofing/Tar Kettle <br /> 1 1 Fire Pumps Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I Flammable Application- ANNUAL Valuation of Project <br /> ) Fuel Tanks <br /> 0 =.. <br /> Other. ) �. <br /> Contractor <br /> !�'-k Company <br /> - Registered Y/ N 1 Fee Current I Y / N <br /> Signature <br /> Address) - License # <br /> ELECTRICIAN Company <br /> Signature Registered _ Y/ N 1 Fee Current I Y / N 1 <br /> Address 1 1 License # ) I <br /> PLUMBER Company <br /> Signature Registered L Y / N 1 Fee Current 1 Y / N 1 <br /> Address 1 I License # 1 <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current Y / N 1 <br /> Address) 1 License# ) <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y / N 1 <br /> Address 1 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 (httpJ /appraiser.pascogov.com) <br /> • <br />