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'80 -0020 City of Zephyrhills "Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date a -,:en 10 Phone Contact for Permit <br /> Owner's Name I Owner's Phone Number I 1 I 1 I <br /> Owner's Address I <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> 1 1 1 I <br /> Fee Simple Titleholder Address I <br /> � -)(� C- (7 3 it} Lot # <br /> Job Address �� 1r <br /> Sub Division Parcel # <br /> 1 1 Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n ry <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum I I 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 r I Places of Assembly- ANNUAL <br /> Itttriy� ) Semi ) Uther <br /> Sprinkler n ❑ • ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ • ❑ ❑ I I I I Sparklers <br /> Hood Cleaning n ❑ • ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression Fro ❑ ,r te/ ❑ I I I Standpipes (Sprinkler Sys) <br /> I <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> ri Flammable Application- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> In Other: I <br /> Contractor ,777/ Company /U� po4 p, , r... , eri." t r :.. 1 <br /> Signature / <br /> Registered Y/ N I Fee Current 1 Y/ N I <br /> Address '17" �iG 1 ,c. 4r r 6/0-d_.-- <br /> -r&.,...,,,- r( I License # r /1632 tl C96,0 racb <br /> ELECTRICIAN Company 7 <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I License # I <br /> PLUMBER Company <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 1 Y' / N i _ <br /> Address I I License # I <br /> of OTHER <br /> Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address <br /> License # <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 (httpf /appraiser.pascogov.com) <br />