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813 - 780 -0020 City of Zephyrhills Fire 4 ! Fax -813- 780 -0021 <br /> Permit Application I <br /> Date Received 1 I Phone Contact for Permit <br /> Owners Name F7 F � " Owner's Phone Number I 'f 3 1 c ;.. , 17�� I <br /> Owner's Address 5 (0 / r) , ,V e - � /t l 5 3 3� 0 <br /> Fee Simple Titleholder Name 77 Titleholder Phone Number I <br /> Fee Simple Titleholder Address <br /> Job Address <br /> Lot # <br /> Sub Division Parcel # <br /> Bio- Hazard Was ; �,.. �.F „�..,:• u .�, ,.,,.v,� _ ",._. __ ;.� _ <br /> I I to Storage - ANNUAL pi Fumigation Tent <br /> pi Comm Exhaust Kitchen Hood /Duct IT Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Controlled Bum I Hood Installation <br /> F 1 Emergency Generator < 30 kw I] LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> {I Fire Protection Maintenance n Places of Assembly- ANNUAL <br /> gag Isemil 621 tither <br /> Sprinkler ID ' p / Recreational Bum i'' 1 Fire Alarm I ❑ ID ffi I I 1 I Sparklers Hood Cleaning I ❑ ❑ ❑ I I Fl Sprinkler System Installations S" ff v <br /> Hood Suppression IT ❑ ❑ ❑ I 1i Standpipes (Sprinkler Sys) <br /> f 7 Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> ri Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> f 1 Fuel Tanks <br /> I Other I <br /> ...A: " _ ...... .... i . ..... / .� K.�#`-.,� �::€ / Paz�t. ...& a1�..nzz..,t, ate ✓.....<.., x.Y .. .,.:; <br /> / ,Wi. 6-`1440,r, BRA <br /> Contractor rip /�l P�f C� �:�...�...: <br /> Company c( CQ2Aa� <br /> Signature Registered Y/ N I Fee Current Y / N I <br /> Address I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address 1 I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address 1 I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N J Fee Current I Y / N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address I <br /> _., <br /> 1 License # <br /> Directions: <br /> ..... _ a.....a ,. z ...,. * . �.: <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 />