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. 813-780-0020 City of.Zephyrhills Fire. Fax- 813 -780 -0021 <br /> • . Permit Application <br /> r I <br /> Date Received <br /> Phone Co <br /> t <br /> ntact for Perrnl <br /> 1 <br /> Owner's Name / g C- c. -4f( v /rs -- ZtA Owner's Phone Number F 3 7" <br /> Owner's Address 3s „s eE A, - //ls / <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> .tea. , <br /> . r.ki':t# `s�«"d� ", lumen �'e.F,l , k 'x� w."'' . .. sicxf`.,n:'42ar1,?'k 'a . •iF: �ns3 `°^?�Y;. ^_,.x„• 4` -^,tt e a+ <br /> Job Address Lot# <br /> Sub Division Parcel # <br /> I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> FT Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> 1 Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL • I I Places of Assembly- ANNUAL <br /> ry . r I tither <br /> Sprinkler r ❑ ❑ ❑ 1 Recreational Bum <br /> Fire Alarm n 1: 0 1:] I J Sparklers <br /> Hood Cleaning ❑ A ❑ I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I n Standpipes (Sprinkler Sys) <br /> 1 Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> ) I Valuation of Project <br /> I Fuel Tanks o <br /> EI Other: <br /> Contractor Company <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address 1 <br /> 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 I Fee Current 1 Y / N I <br /> Address I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N _ Fee Current Y / N <br /> Address <br /> License # <br /> OTHER Company _ <br /> Signature r'� Registered IM Fee Current Q <br /> Address License # <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> tf 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 />