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813-780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received J P K) Phone Contact for Permit <br /> Owner's Name � j( , 3 1-1i Be-q tvvnihK /or, Owner's Phone Number y) 3 115 a 2-4 q- <br /> Owner's Address 39dac Yr ' Arc h +I IA <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address Lot# <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL pi Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> r -- 1 Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> 1 Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> JUtriy1 1Semil I""' Uther <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm 1 ❑ ❑ Sparklers <br /> Hood Cleaning I ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> 71 Fuel Tanks <br /> I Other: I <br /> ns".....•. ' ":a ::,,..e ;: ;>.:'" .. - ;""ra'6'�c "., .uxi" ,::6', `�.°�u... 'r ,"- "e',s%'u�.-wi: .. a.;>:+ wa ;.. c.�a 0: ` itatZwx;.x,. latiwr. wlitV c . rat" k.';- ,:...c�.MAgear. '., :gliL.,,:E:a. ':: .' ;i- ,,...:,.e ^.Zat:M;iaLM....._.,.. <br /> Contrac •r Company Gl >1 <br /> Signature 115 Registered Y / N , ee Current I Y / N <br /> Address 1 4 ql Inl J -fl 12R 'Try 33,3 I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N � Fee Current Y / N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N j <br /> Address I License # I <br /> OTHER Company <br /> Signature Registered Y/ N J Fee Current 1 Y / N <br /> Address I 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 (http: / /appraiser.pascogov.com) <br />