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813 -780 -0020 City of.Zephyrhills Fire' - Fax- 813-780 -0021 <br /> Permit Application _ _ <br /> Date Received '1 a) v Phone Contact for Permit <br /> Owner's Name 1a- \ur 1- 1 f 4-k. �G.ZaY'P Owners Phone Number <br /> Owner's Address a c 1 V i Z-- r3L \`S i F--1- 3 sLI <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple - Titleholder Address I I <br /> Job Address \ d' -S--1- J j j 1 Lot # <br /> Sub Division Parcel # <br /> Bio -Hazard Waste Storage - ANNUAL n 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 /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 1 �Utnyl �SemiI la1 Utner <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning pI ❑ ❑ ,ice I 1 n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ I I n 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 /> n Flammable Application- ANNUAL ` ( Valuation of Project <br /> El Fuel Tanks <br /> n Other: I I <br /> Contractor Company , a a G .. rcz r Iv, h41-, - <br /> Signature c-1 Registered MUM Fee ' ent Y / N <br /> Address r _ <br /> �� � • • �1 _tea ■ \ _ _ .; • License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N J Fee Current I Y / N J <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N ,I Fee Current I Y / N j <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <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 /> 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 />