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813 -780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021 • <br /> Permit Application <br /> Date Received Phone Contact for Permit I I I <br /> Owner's Name I - 2 - E - R12-y + S L Iy 5 L /214 (2. i IA C Owner's Phone Number d i 3 7 S.2- 161 161-0 Owner's Address k 3'70 7 && LI 66 g 'UU <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address i 6:707 6—pt LL 73 l t d . Lot # <br /> Sub Division <br /> Parcel <br /> I I Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw - LP /Natural Gas - ANNUAL S. <br /> n Fire Protection Maintenance - ANNUAL IW/ Places of Assembly -AN i AL <br /> (Gttrlyi Ibemi I FT] l)ther � 941'5 <br /> Sprinkler ❑ ID ED MI Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression E ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> I I Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> FT Fuel Tanks <br /> I Other: I <br /> i ,:z.. . . -..w _ _ � ._ , 4_. :za . _. M.... ..a,.ae �Y..� . : . . .1A1.� gg. ._ . M. . . .. . G�. . ... _._ .. q_ .._. <br /> Contractor Company L/" ..--- I <br /> Signature - <br /> ---(. 7 �( µ� Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current Y / N I <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I 1 License # <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I License # I <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 />