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813-780 -0020 City of Zephyrhills Fire- -f 2 QC) Fax -813- 780 -0021 <br /> Permit Application 1 <br /> Date Received 1 Phone Contact for Permit l J A (0 <br /> Owners Name ��� Z Ql�` Owner's Phone Number �/3 17� � <br /> Owners Address 1 3t £ - \ k J + t <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> .., 3= 9�r.•� _ , £� ..., ...,,,�.,�.�,.. �, :a •:�: < � „' „s� d'#`�- «'dm' - - :x.,..._.�, ? raw <.' _.,�`.:> �, .���:......... .. �. �c�..;.� �. �P�r'" 3 ;e'z�s�,�:�? „a�`..�- .i..az,.. -. �: xw,- �..°' =i; <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LPlNatural Gas - Installation <br /> Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> lwirij (Semi) J Other <br /> Sprinkler ❑ ❑ �q0�` I I Recreational Bum <br /> Hood Cleaning n ❑ ❑ ❑ I ( n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes ( Sprinkler Sys) <br /> n Fire Alarm Installation n Torch RoofinglTar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL ( ( Valuation of Project <br /> Fuel Tanks <br /> n Other: <br /> :e , <br /> Contractor Company ► <br /> Si Registered <br /> nature a ^ ` <br /> 9 �,��� l�M� �� � ee Current <br /> Address '� !, .l�f ► . f( C ' License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N <br /> Address I ( License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current Y / N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N j Fee Current I Y/ N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current I Y/ N <br /> Address ) l License # J <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 />