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813-780-0020 City of.Zephyrhills'Fire Fax - 813 -780 -0021 <br /> Permit Application <br /> •• <br /> Date Received <br /> Phone Contact for Penult <br /> �� �� (JL ,p� � ey � � `` ✓ l� '_ <br /> Owner's Name .. w�.^�7..�..�..,.. <br /> / - ` G4 /C r - Owner's Phone Number O /3 11 I I / / / y <br /> Owner's Address 3 9 c3 Y5 4 ii r e/43 3 35 C `z <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> F <br /> 1 <br /> ee Simple Titleholder Address <br /> Job Address <br /> Lot# <br /> Sub Division Parcel # <br /> ar <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL • I I Places of Assembly- ANNUAL <br /> lUtrlyl . 1Semil . ri Uther <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ 0 1 I Sparklers <br /> Hood Cleaning ) ❑ ❑ 4 n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ! Valuation of Project <br /> Fuel Tanks <br /> 7 Other: ) <br /> Contractor Company T /�S S� ✓C ��s <br /> Signature <br /> Registered Y / N Fee Curret/ Y / N <br /> Address d .S I C J i ^. ✓ oL ; r�y� /tY�,L r r ( I - 7 c L # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N j Fee Current I Y / N <br /> Address I I License* <br /> PLUMBER Company <br /> Signature Registered Y / N _ I Fee Current I Y / N <br /> • <br /> Address I <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address <br /> License # <br /> OTHER <br /> Company <br /> Signature Registered Y / N 1 Fee Current 1 Y / N - I <br /> Address I License # <br /> .�. <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 />