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813-780 -0020 City of Zephyrhills Fire q Fax -813- 780 -0021 <br /> Permit Application i <br /> Date RecehrEid ► Phone Contact for Permit <br /> Owners Name � w : � � ��� Owner's Phone Number I <br /> Owner's Address 3 7 %6 £ Ai 0 7(64 k7r. <br /> Fee Simple Titleholder Na ?e" G . <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> .: . ,;.. - A t s ., €A p:,?.. r. 3 "MgRI :tea „M Vii.. : 'FAME Q om,: ; r �eI R d, 7 "� RI «r. 'L.> - � .. b Na '�'v a <br /> Job Address p / (� /� <br /> 3 0 3 6 1 C�zL r o„ % 1 �' 2 F" Lot <br /> Sub Division / Parcel # <br /> .z• <br /> .'; m" .",,.:. ,. 6 F, ia_Ewt,..„.,.o.a.4emi'4 vit'L; *.,,raS2%.4E xw., ..�'d"> mri.rovinit.',:mis. . <.??"w.. .. h », ,�.i ? :a <br /> - <br /> I Bio- Hazard Waste Storage - ANNUAL II Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I — I Fire Protection Maintenance - ANNUAL Places • of Assembly- ANNUAL <br /> ILitrlyl ibemil Other <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I ( Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ I I I-( Sprinkler System Installations <br /> Hood Suppression 7 ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps I- Waste Tire Storage ANNUAL <br /> I - 1 Fire Works <br /> n Flammable Application- ANNUAL ` I Valuation of Project <br /> El Fuel Tanks <br /> n Other: I <br /> Contractor �� Company I <br /> Signature , il,... ,1 Registered Y/ N I Fee Current I Y / N I 1 <br /> Address I �' J <br /> I License # <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I <br /> I License # <br /> PLUMBER Company <br /> Signature Registered Y / N j Fee Current I Y/ N j <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N _I Fee Current I Y / N J <br /> Address <br /> I License # <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address J License # <br /> Directions: <br /> ions: <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 />