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813-780-0020 City of.Zephyrhills Fire. C � . Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received i W a 0 <br /> - Phone Contact for Permit <br /> Owner's Name L 4S2 L.Q i LTO V 4 Owner's Phone Number .e / r -s <br /> T c --- , ?3 <br /> Owner's Address ?O 1ji q2? 'H 3 3 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> .HZ� }S.,. ,y. z.;. ' ^, 4,.u,Mr, x . -,e, -. . ` ''' •.,-• , ,,, h ta:x ads /' ,,,,,,,,, r pf, , -- . r ` '_, ter: =ttk . = > 't <br /> Job Address (r L � i //(/ 7, !JC J/V SO4S YILt 2 L1' Lot# <br /> Sub Division Parcel # <br /> I Bio- Hazard Waste Storage — ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL ( I Places of Assembly- ANNUAL <br /> Iutrlyl IbemiI J Uther <br /> Sprinkler n ❑ 0 I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning c/ I ❑ V ❑ I I I Sprinkler System Installations <br /> Hood Suppression I ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> Ti Other: I <br /> Contractor Company CV/ fr rs S ' 0 UJGE.S <br /> Signature < =3 Registered Y / N Fee Current I Y / N <br /> Address I License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current Y / N <br /> Address I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N _ Fee Current I Y / N j <br /> Address I <br /> I License # <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N j <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 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />