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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 Permit Application Date Received Phone Contact for Permit 13os" 1131'3 1 1 Z T3 1 Owner's Name I 1 41/11 2 4 3 I I Owner's Phone Number I 11 11 Owner's Address I Fee Simple Titleholder Name I Titleholder Phone Number I 1 I I Fee Simple Titleholder Address Job Address - 19 - a- & t1 SLV b I Lot # Sub Division I Parcel # n Bio- Hazard Waste Storage - ANNUAL a Hazardous Material (Tier II or RQ Facility) ANNUAL a Comm Exhaust Kitchen Hood /Duct n Hood Installation El Controlled Bum = LP /Natural Gas - Installation El Emergency Generator < 30 kw In LP /Natural Gas - ANNUAL Sale El Emergency Generator > 30 kw n Places of Assembly- ANNUAL El Fire Protection Maintenance - ANNUAL =I Recreational Burn ry 'Semi' WO Other Sprinkler D ❑ ❑ ❑ = Sparklers Fire Alarm 0 ❑ ❑ ❑ 1 1 n Sprinkler System Installations )D i/ Hood Cleaning 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) C:/, q I Hood Suppression t ❑ `YL ❑ I 1 n Torch Roofing/Tar Kettle El Fire Alarm Installation n Waste Tire Storage ANNUAL Fire Pumps Fire Works Flammable Application- ANNUAL 1 ( Valuation of Project Fuel Tanks Q Other: I I Contractor Company thi� (F1f _....--r ___ ___,--------Th Signature .. Registered Mit N I Fee Current I Y/ N I Address 116‘ Mt%) '2A6 flJe NA1A14i 1 ft. .‘31 I License# totigl ict As- I ELECTRICIAN Company I Signature Registered Y/ N 1 Fee Current I Y/ N I Address I I License # ( I PLUMBER Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I i License # I I MECHANICAL Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I OTHER Company I Signature Registered Y/ N 1 Fee Current I Y/ N 1 Address I I License # I I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)