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813-780-0020 City of Zephyrhills Fire Fax- 813780 -0021 <br /> - Permit Application <br /> Date Received �Q a 0� I <br /> w Pho neContactforPennit� .1. „ „w,.� <br /> Owners Name J\ r)C, ! y Z')_(� J Owner's Phone Number S ` I I 1 Sb� <br /> Owner's Address �jq C,rc l 1 \ r <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> �,'� �'�,'�.� �'�': s R.a�."� ,fir "��� 3 ?xE? <_ _., e�`� »�, ±�`�vk x "..., x"•.t �?",� .; ,���aR*�z �?'.,:�r�s��;r��' a. �,"...�t m R . ,�' ” � �” <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> .':. �5' x,`.. r. i,�c`:''.. +. �.g „ "'�a.. ,._�. w;.es'.!'.. E.w'&3a.�t "9 <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 /> 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 I I Places of Assembly- ANNUAL <br /> Utnyl IbermI [1ill Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> (� Flammable Application- ANNUAL ( I Valuation of Project <br /> J] Fuel Tanks <br /> [� Other: <br /> Contractor Company <br /> Signature Registered Y/ N J Fee Current Y / N <br /> Address - � -� r License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address ( License # <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N <br /> Address <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address License # J <br /> .v- • <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 />