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.it N-CTO <br /> 813- 780-0020 City of.Zephyrhills Fire Fax-813-780-00,1 <br /> Permit Application <br /> Date Received Phone Contact for Permit J <br /> Owner's Name IA/ Q G n 0 �/�t� Bp��( �G + c9 � /4-s561 �i, Owner's Phone Number . , <br /> Owner's Address �' 230 .•i J <br /> • Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Address ) <br /> Job Address 5 30 IQ +" 5 Lot# <br /> Sub Division Parcel# <br /> . . <br /> n Bio-Hazard Waste Storage - ANNUAL ED Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct = Hood Installation <br /> n ) Controlled Bum . F - 1 LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator> 30 kw J-I Places of Assembly-ANNUAL <br /> Fire Protection Maintenance - ANNUAL J Recreational Bum <br /> t y emi E23 Uer th <br /> Sprinkler CI ❑ ❑ ❑ / 1 7 Sparklers <br /> Fire Alarm / E ❑ 1:1 sQ J ( n Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ J ( El Standpipes (Sprinkler Sys) <br /> Hood Suppression CI ❑ ❑ ❑ J I n Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation 1 Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> n Fire Works <br /> n Flammabie Application- ANNUAL I Valuation of Project <br /> E Fuel Tanks <br /> Q Other. J <br /> legiallEMOSMal <br /> Contractor 0 73" – ■ C ' ' w Company 1✓ � . - /[/ ° Registered Y / N Fee Current Y / N <br /> Address / License# I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N j Fee Current 1 Y / N <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y / N J Fee Current I Y / N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # I I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current 1 Y / N j <br /> Address License # 1 <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 52500, 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 />