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• <br /> 813 -780 -0020 City of.Zephyrhills Fire. Fax -813- 780-0021 <br /> Permit Application <br /> Date Received <br /> Phone Contact for Permit <br /> Owner's Name e- s �c_/� S gloAftAkS Owners Phone Number 1 I 1 l <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> care .l�$a.vNkr+z�L,"Ixi"�^trxik'# // mF 4 Z C / �� .a.sCk &9'h ry.v hs-i NAB �i4LL r ` `. J) - <br /> Job Address ( `J <br /> �/ Lot # <br /> Sub Division Parcel # <br /> _. $'44) . <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> FT Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> FT Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> lUtnyl !Semi Other <br /> Sprinkler D ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ j ❑ ❑ I I n Sparklers <br /> Hood Cleaning I ► 11 ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression E] ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application - ANNUAL <br /> 1 1 Valuation of Project <br /> Fuel Tanks <br /> fl Other: Ar ...0/ <br /> Contractor Signature _��i� Company -1t` <br /> / Registered Y / N Fee Current Y / N <br /> Address / License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N ] Fee Current I Y / N <br /> Address I <br /> I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I <br /> 1 License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N J <br /> Address I I License # <br /> OTHER Company ;S, ' tie. / flf <br /> Signature Registered IMAM Fee Current ,,�Q <br /> Address ' ffl License # <br /> Directions: � .. __ • �. _ : �-3 .> . »,,._. <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 />