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City ofZephyrhillsFirs• Fax-S-13-780-0021 s1 7so ouzo Permit Application <br /> Phone Contact for Permit <br /> DatRecelved. .W /� Owner's Phone Numb l e% ��o� 70 <br /> • ' ( '70s2Ji . <br /> Owners Name 1 y <br /> Owners Address P� J <br /> ._._....___.__.______ Titleholder Phone Number <br /> Fes- Simptefittet edellEme'- -_ <br /> ' -_ _ ,� <br /> er ftddfess ,_. <br /> Fee Sim Ie3fE[akreld <br /> - Lot ;u <br /> /' ' I ',;11 /L- a <br /> Job Address v' At. ) <br /> Parcel # I <br /> '. •,.._.rX Y ' u . . � ter. .� <br /> Sub Division _ ,... .,,..,..:. <br /> Fumigation Tent <br /> , Bio- Hazard Waste Storage - ANNUAL <br /> Hazardous Material (Tier II or RO Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct <br /> Hood Installation <br /> - Controlled Burn <br /> FT LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw 1 1 LP /Natural Gas - ANNUAL Safe <br /> Emergency Generator> 30 kw <br /> Places of Assembly- <br /> Fire P ANNUAL > <br /> Protection Maintenance - ANNUAL <br /> It-RI '�semlI (illy 1 <br /> Utner ri ❑ ❑ ❑ I u Recreational Bum <br /> Sprinkler <br /> Fire Alarm <br /> J ❑ ❑ ❑ 1 I I Sparklers <br /> n ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Cleaning <br /> J Ir <br /> Standpipes (Sprinkler Sys) <br /> Hood Suppression ❑ ❑ ID <br /> n Fire Alarm Installation I' I Torch Roofing/Tar Kettle <br /> • <br /> I I Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works Valuation of Project <br /> I I Flammable Application- ANNUAL . 11111111111111111111111111111 <br /> .1 I Fuel Tanks <br /> n Other: 1 <br /> Company . <br /> Contractor //�� � Registered Y / N Fee Current Y / N J <br /> Signature i v . .4 /) �_ '•1/.� • <br /> Address] License # 1 <br /> ELECTRICIAN Company Registered L Y / N 1 Fee Current I Y / N <br /> Sicnature <br /> Address .1 ] License # 1 <br /> PLUMBER Company <br /> • Registered Y / N I Fee Current L Y / N <br /> Signature <br /> Address 1 1 License # <br /> MECHANICALI Company <br /> Signature 1 Registered 1 Y / N I Fee Current I Y / N <br /> Address '1 License# 1 <br /> OTHER Company <br /> Signature Registered Y / N 1 Fee Current 1 Y/ N <br /> Address . <br /> ense <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 />