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818 780 -00211 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received I act fo <br /> Phone Cont r Permit I 1 I <br /> Owner's Name r-t 1 .--- r-s. 1 Owner's Phone Number <br /> Owner's Address ' �- - tta\ \ Q cti —I—e- t---r-A -' \ 1`— \ -- +\ <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address ' ---- 1 ` L \...v C Q--,\ . , c-!.\ Z- P C-----'"--1"---'. 1 \--. x_ \ 3�S ,_S■ \ Lot # <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL 1 A Places of Assembly- ANNUAL <br /> IUtrlyl }SemiI mg Other <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression Ell ❑ ❑ ❑ I I Standpipes (Sprinkler Sys) <br /> n 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 <br /> 1 I Valuation of Project <br /> I Fuel Tanks <br /> El Other: I <br /> Contractor Company I <br /> Signature 'r -. ____'- -- 9 --� Registered Y / N I Fee Current I Y / N <br /> Address I I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I 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 />