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813-780 -0020 City of Zephyrhills Fire Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received 'l Phone Contact for Permit <br /> Owner's Name Qud1,4 / � j � Owner's Phone Number <br /> Owner's Address 1 8/5 �1 8 %'a' <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 48i5 �p.// ,g/ Lot # <br /> Sub Division Parcel # <br /> I I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I I Hood Installation <br /> I 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> lutriyl 'Semi) tither <br /> Sprinkler ig ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ d 1 n Sparklers <br /> Hood Cleaning in ❑ ❑ ❑ I I 1 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ ' I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I Flammable Application- ANNUAL I I Valuation of Project <br /> FT Fuel Tanks <br /> n Other: I <br /> . ,.,....c .___._: ,.,k ,:orgm 440.L- z. . 0,fmagool :::,. .. :,i ..... ... . ; : ::a . L...,.,,:,u _ 2. .,a : ._..._ 2:ER.t au._,,La• <br /> Contractor , / T� Company _���rrs /{i" r .S.,.S.,..4,/ � 1 <br /> Signature G(/ V Registered Y / N Fee Current J .S.,..4,/ Y / N . / <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N 1 <br /> Address I I License # ( I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> 1 License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> 1 License # I <br /> OTHER Company <br /> Signature Registered Y / N . 1 Fee Current Y / N <br /> Address I I License # <br /> Directions: ....... �...�.P _ �: s...:� <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 />