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813 -780 -0020 City of.Zephyrhills Fire Fax- 813 -780 -0021 <br /> � ca/-117 'Permit Application <br /> Date Received I <br /> Phone Contact for Permit <br /> Owner's Name 4S `,-_V cte Z7)-- , I <br /> Owners Phone Number 1 I I <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 I 1 <br /> Fee Simple - Titleholder Address I <br /> Job Address L-_,) , ‚2 - <br /> ' > i' - '",.-4 Lot # <br /> Sub Division Parcel # <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 1I or RQ Facility) ANNUAL <br /> n Controlled Burn n Hood Installation <br /> n In Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> El <br /> • <br /> Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL / /1 <br /> �Qtriy1 !Semi' � Other <br /> 4/ /v% �( <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ <br /> Sprinkler System Insta ations xx r ✓ <br /> Hood Suppression n ❑ ❑ ❑ I n Standpipe (Sprinkler Sys) ! , ;�P� °!/ 0 <br /> n � <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle �r';,, . � � <br /> 7 I— Waste Tire Storage ANNUAL ' fir L'I <br /> Fire Pumps <br /> n Fire Works <br /> n Flammable Application- ANNUAL I <br /> Valuation f Prol -ct <br /> n Fuel Tanks <br /> n Other: <br /> Contractor C _ - - =i � Yr ' <br /> � . _ Company �b L�(A ' i ��... A / f. <br /> Si j" <br /> r <br /> Registered Y / N Fee Current Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N j Fee Current I Y / N j <br /> Address I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N J Fee Current I Y/ N 1 <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N j <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: <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 />