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813- 780 -0020 City of Zephyrhills Fire. Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit I 1 1 <br /> Owner's Na` .._ . ��� <br /> me I , j��/ // 'C S�.ri70Ai I Owners Phone Number I 1 1 1 I I <br /> Owner's Address 1 38'x/ /O 6 Z�hy/A /4 t_/ w l I <br /> Fee Simple Titleholder Name .. Titleholder Phone Number I 1 1 I <br /> Fee Simple Titleholder Address <br /> Job Address Lot <br /> Sub Division <br /> Parcel # <br /> ..., lixi wa w. i'lzxx .firasgisifiv.,:;ss ., iAmo ,. ,— m _ , or , .,. :ate w. w^T :.. w xzz =z7 =ma,II. >4s",,,.,:i.Qo m- e. ,. <br /> e+ -.'v., 'h. 4 vka6o ., s.x' ..»w enw ,ggH4...JE.,.i.,. a. ✓..: • <br /> Bio- Hazard Waste Storage ANNUAL J ] Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I Hood Installation <br /> I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw r--- LP/Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> ILitrlyl lbemil Fri 1 Uther <br /> Sprinkler ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning 7 ❑ 0 ❑ I Sprinkler System Installations <br /> Hood Suppression IX ❑ A ❑ I I I Standpipes (Sprinkler Sys) <br /> Ii Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ! ( Valuation of Project <br /> I - Fuel Tanks <br /> n Other: I <br /> Contractor �_. ,., st. s ..E. cox *;•: <br /> Company <br /> Signature Registered Y / N .. Fee Current I Y / N <br /> Address I I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N j Fee Current ( Y / N <br /> Address I <br /> 1 License # <br /> MECHANICAL <br /> Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # <br /> OTHER Company ' 4....• /7 /� <br /> Signature Registered ram= <br /> 9 r�� Fee Current <br /> Address <br /> Directions: �x ro Lice ns s,. <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 htt //a <br /> P Y ( p: ppraiser.pascogov.com) <br />