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813-780-0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> Permit Application <br /> Date f Received 1 5- - 1 fiA Phone Contact for Permit = I ,0 l I 1 S i3I <br /> Owner's Name I F l/ t( 0f o af /�G.. tio ( I Owner's Phone Number 1 1 1 I <br /> Owner's Address I 1 0 S ^ ( 1 rill- _ 1 I 1 ?' v j <br /> Fee Simple Titleholder Name I Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> Job Address 7i�0 I ( Dui?, Lp y r 4 i) / ,c / Gj Lot # <br /> Sub Division I / Parcel # I <br /> n Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n C ontrolled Burn n LP /Natural Gas - Installation <br /> n E - mergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> F - 7 Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> PI Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> (QtrlyI (Semi) Fill Other <br /> Sprinkler n ❑ ❑ ❑ n Sparklers <br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> i1 <br /> Hood Suppression ❑ X ❑ I I n Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> n Fire Works <br /> n Flammable Application- ANNUAL ( I Valuation of Project <br /> n F - uel Tanks <br /> n O ther: I I <br /> Contractor ( 7 „� rr'� Company CI 7 4 -Pt-e_ ACJ� - c 74,-/,-- 74,-/,-- I <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address 00) -3D — r , Ptr-/✓h ,D Tit - .fin FL 3 .I' j License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address <br /> I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> OTHER Company I <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address ( I 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 />