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n ` 51 l ys -- .ate <br /> • 813-780 -0020 •(; Cit of Zephyrhills Fire l. Fax- 813-780 -0021 <br /> - 4 t Permit Application <br /> Date Received r <br /> - Phone Contact for Permit J Fir <br /> a <br /> Owners Name ill a r-1-- I Owner's Phone Number I I <br /> Owners Address fit 72 r` '7 (.. C )i V' 6 <br /> Fee Simple Titleholder Name Titleholder Phone Number I <br /> Fee Simple Titleholder Address <br /> Job Address L 1 27__ (' 1 A= A V b T tY1 U ' 0 S - (_',(a v C Lot # <br /> Sub Division 1 Parcel # <br /> El Bio- Hazard Waste Storage - ANNUAL a Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum h Hood Installation <br /> a Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> ED Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANN AL n Places of Assembly- ANNUAL <br /> um magi uili other <br /> Sprinkler 151 - ❑ ❑ n Recreational Bum <br /> Fire Alarm 0 ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation ri Torch Roofing/Tar Kettle <br /> Fire Pumps ED Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> Fuel Tanks <br /> fl Other:i <br /> Contractor (V Company k- .0Nt.( f42 2Ill < <br /> "1 t(L,E3 1 <br /> nature Registered N Fee Current Y / N <br /> Sig Mir <br /> Addre ss Frlii L `v MAIM et / rri MII License # iffira►'Ltal�'�' <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company 1 <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # 1 <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current L Y/ N <br /> Address I I License # <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address License # <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 />