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813 -780 -0020 City of Zephyrhills Fire Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received I 1 Phone Contact for Permit I 2} I q.y .z I I( q a 3 <br /> Owner's Name Eli= ,/ / �� Owner's Phone Number 17 <br /> f 3 17 (a 1 1 4,50 0 <br /> Owner's Address 7 64 Pia 2e 1 �/ / /S' , ( 3 Y5f ( I <br /> Fee Simple Titleholder Name / / Titleholder Phone Number <br /> I <br /> Fee Simple Titleholder Address I <br /> Job Address <br /> Fi Lot � ��/���� � � � Lat # I l <br /> Sub Division <br /> Parcel # <br /> rI Bio- Hazard Waste Storage - ANNUAL (i Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 0 Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> a Controlled Burn I-I LP /Natural Gas - Installation <br /> a Emergency Generator < 30 kw pi LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator> 30 kw I I Places of Assembly-ANNUAL <br /> I CI Fire Protection Maintenance - ANNUAL 1 I Recreational Burn <br /> F5791 ISemil Flit <br /> Sprinkler I)` t y ❑ ❑ I I Sparklers tr .- <br /> Fire Alarm 7 ❑ ❑ ❑ ( I I ( Gn <br /> Sprinkler System Installation � ((/ <br /> Hood Cleaning ❑ ❑ ❑ I I 1 Standpipes (Sprinkler Sys) <br /> Hood Suppression El ❑ ❑ ❑ I I E Torch Roofing /Tar Kettle <br /> n Fire Alarm Installation I} Waste Tire Storage ANNUAL <br /> El Fire Pumps <br /> IT Fire Works <br /> 7 Flammable Application- ANNUAL I <br /> ❑ Valuation of Project <br /> Fuei Tanks <br /> ri Other: I <br /> Contractor I Company n . T <br /> Signature /� .So 4. 07 <br /> Registered Y/ N Fee Current I Y / N I <br /> Address 35 31 1$1e4,54-o „e, I License # I Q2 35 A SOOO I a oo z <br /> ELECTRICIAN I I Company I <br /> Signature Registered Y / N ,I Fee Current Y/ N I <br /> Address I I License # I <br /> PLUMBER I I Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address <br /> 1 License # <br /> MECHANICALI <br /> Signature 1 Company I <br /> 1 Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER I Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I I <br /> Address I I License # <br /> Directions: <br /> Fit 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 />