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- 813- 780 -0020 City of.Zephyrhills Fire e Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> s, <br /> Owner's Name U PS SZGl1k Owner's Phone Number L .. ..,,. I I <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number I l <br /> Fee Simple Titleholder Address 1 <br /> r ,. <br /> ., . ,':: F...�..,^�:.� ,.. ,.w... �,. a� Mir. ... <br /> Job Address 781 0 6-A u- L LVil. Lot# <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I l Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum OD I Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale h l 2 0 <br /> n Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL /U _%,----- <br /> 1Utrly1 !Semi' Fin Other <br /> Sprinkler I ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm 7 ❑ ID I I Sparklers <br /> Hood Cleaning 7 ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I [I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I7 Torch Roofing/Tar Kettle <br /> I Fire Pumps 1 1 Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> n <br /> Other: gEuNe'A'1'►oN of A . !� CS TN 72,#••4"0-T 72,#••4"0-T SP <br /> ..,. 11 : a"-'"R,,. . wu� . � a `�,r`. 'fie+..«:.i':.. 1* , 4, .��» :'r: r=±._< ¢z • �.,, ...:r . . za > et w MiarG :MI .. �.. rekt wa a. :m.�a o. .. <br /> Contractor Company F } r Q f Sac. V ail Y /Ga �N.uatytifi <br /> Signature �� <br /> `Registered N Fee Current I Y / N <br /> Address <br /> _I License # EF y y. <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y / N . 1 Fee Current 1 Y / N _ <br /> Address I <br /> I License # <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address 1 I <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y / N _ Fee Current I Y / N j <br /> Address I <br /> I License # <br /> OTHER <br /> Company <br /> Signature Registered Y / N ] Fee Current I Y / N <br /> Address <br /> License <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 />