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613-780-0020 City ofZephyrhills Fire, Fax- 813-780 -0021 <br /> . Permit Application <br /> eceived 14 ,.._, Phone Contact for Permit I <br /> lees Name /j rip�fSQr/y AIL Owner's Phone Number 1 F/3 l 205 U3,7 <br /> Owner's Address 37 s J.- /3 p,1 <br /> Fee SimpleTitleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address , 3 7S/5 /4 64 /rive Lot # <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage – ANNUAL I I Fumigation Tent <br /> El Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Fa ' • ANNUAL --.‘, <br /> Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation t� /� <br /> n m <br /> Eergency Generator> 30 kw n LP /Natural Gas - ANNUAL -ale f / <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly -ANNU <br /> f I Semi) Other <br /> 1 %:Lpr! er _ fd i` ) ❑ ❑ n Recreational Bum <br /> '', i - Alarm MI ❑ 3a ❑ I ( Sparklers <br /> Hood -:ning . ❑ ❑ ❑ I I ( Sprinkler System Installations <br /> _----- <br /> ❑ <br /> Hood Suppression ❑ ❑ ❑ . I 1 n Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL i 1 Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor Company _ <br /> Signature a7---- <br /> � Registered �� Fee Current 21041. <br /> Add _. i I <br /> License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current I Y/ N <br /> Address I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y / N J Fee Current I Y / N <br /> Address I License # <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N j <br /> Address <br /> License # <br /> Directions: • , .. _ .t _t <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 />