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813 -780 -0020 City ofZephyrhills Fire, Fax- 813 -780 -0021 <br /> Permit Application - <br /> Date Received I I Phone Contact for Permit <br /> "rte E >> __ �// // <br /> Owner's Name LS ; (� // !J 4) ,t4hi<e- Oswt- 4 Owner's Phone Number F/3 I 7102 I / / i i <br /> Owner's Address 3�'(p iS— / y / 2r� - //s iG - <br /> f.- /4"nlS /"� � � <br /> Fee Simple - Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I rHt 4 , <br /> " <br /> Lot # <br /> Job Address <br /> Sub Division <br /> Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> n 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 n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> )utrlyI'Semi' Fil LItner <br /> Sprinkler 7 ❑ ❑ ` n Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning 3 ❑ g ❑ I 1 I 1 Sprinkler System Installations <br /> Hood Suppression ❑ g ❑ I I El Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Are Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: 1 <br /> Contractor Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> • Address I � License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address 1 I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I 1 License # <br /> OTHER Company .: r/ , LG <br /> Signature 441111 Registered 1111W�i Fee Curr" . ekgji <br /> Address License # 1/4.0.25V:2000/ -700(0 <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 />