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813 -780 -0020 City of ZephyrhillsFire. -44 (0 313 Fax -813- 780 -0021 <br /> Permit Application _ <br /> ate Received ' --- c ,2 7-A� , - Phone Contact for Permit ►i7/ IfIrla <br /> Owner's Name Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> ks� - �.. a a� f��� <br /> Job Address (P J S T U I J I 1 f0� 'd' Lot # <br /> Sub Division / tiff 0 / 1 KS /�� � Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 1I or RQ Facility) ANNUAL <br /> 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 /> 1Lttny1 'SemiI OA tither <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ L I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation / o v n Torch Roofing/Tar Kettle <br /> H Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 ( Valuation of Project <br /> I I Fuel Tanks <br /> n •they <br /> r z. •r {,N- k:..0 _.. --r .. .+.:, ,'; e .r, u ._ "4r a:., ..,w �, _w #_>a ."m _ice s* .oxi ,,.1, �v s...ir <br /> Contractor I i Company L��� <br /> Signature 1 � I, `, Registered .°J Fee urrent Y / N <br /> Address , License # ��hnLt m' <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address I I • License # ( I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y / N <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 />