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813- 780 -0020 City of Zephyrhills Fire. Fax- 813 -780 -0021 <br /> Permit Application <br /> )ate Received -- � Phona Con I <br /> tact for Permit (I 1 1 <br /> ate Received »ems r r 1 1 _ <br /> )wner's Name / a A <br /> �� C _ � • .r.. .. ( � � r , _ Owners Phone Number I 1 �s5(� <br /> )wner's Address 3 S ! l.. ig C 1 -ci 5`� e-,,L � i 1 t S f I r <br /> -ee Simple Titleholder Name Titleholder Phone Number (I I I <br /> :ee Simple Titleholder Address I <br /> Job Address <br /> Lot # <br /> Sub Division I <br /> Parcel <br /> n Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> E Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw ri LP /Natural Gas - Installation I/ <br /> p Emergency Generator> 30 kw I ( LP /Natural Gas - ANNUAL Sale / <br /> sk7 <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL j( /I 0 / <br /> •; (Semi 1 1 !tither <br /> Sprinkler 1 ❑ ❑ ❑ Recreational Bum <br /> Are Alarm ❑ ❑ 1 1 n Sparklers <br /> d _ ._, <br /> Hood Cleaning ❑ ❑ 0 1 1 1 Sprinkler System Installations <br /> � <br /> Hood Suppression ❑ ❑ ❑ 1 ` I Standpipes (Sprinkler Sys) <br /> rI Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> [1 Other: I <br /> Contractor Company kucuk,ry yll n <br /> J i- S � C <br /> Signature <br /> Registered / N j e Current 4.,...D N f <br /> Address 3'�j Ci Hke,LbaS� t �� Q C I ' <br /> ELECTRICIAN Company <br /> Signature 1 Registered Y / N I Fee Current I Y / N j <br /> Address I I License # <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y / N Fee Current Y / N <br /> Address I I License # <br /> MECHANICAL I Company <br /> Signature Registered Y / N j Fee Current I Y/ N I <br /> Address I License # I <br /> OTHER ` I Company <br /> Signature II 1 Registered Y/ N j Fee Current I Y/ N I <br /> Address <br /> .... �„w� .. License # <br /> Directions: ..,,kaa =u,k x: :Ma <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over 52500, 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 />