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813-780-0020 City of.Zephyrhills Fire <br /> Fax-813-780-0021 <br /> „� Permit Application <br /> Date Received <br /> Phone Contact for Permit <br /> to <br /> ct <br /> a.. nx`� fi ^,Y- -?z. U 'N2.yc- 4sywia "3. <br /> Owner's Name I kt f . <7 1 0;540 I Owners Phone Number Ig I 1 783 I I ` I <br /> Owner's Address I ,315 Z,e ,dye r 2 / // ) i ^ I <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 1 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address <br /> 1 I Lot # I I <br /> Sub Division I Parcel # I <br /> Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> n Emergency Generator < 30 kw 0 LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I= LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 'Qtrlyi'Semi Other <br /> ❑ Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning 0 ❑ g. ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ gr ❑ I I El Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps a Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I I <br /> f ] Valuation of Project <br /> n 1 Fuel Tanks <br /> n Other: I <br /> Contractor I <br /> Company I <br /> I „ <br /> Signature <br /> Registered Y / N I Fee Current I Y / N <br /> Address I I I I <br /> License # <br /> ELECTRICIAN I <br /> Company I <br /> Signature I Registered Y/ N J Fee Current I Y/ N <br /> Address I I I <br /> License # <br /> PLUMBER <br /> Signature I Company <br /> Registered Y/ N ] Fee Current I Y / N j <br /> Address I I I <br /> License # <br /> MECHANICAL' I <br /> Signature Company <br /> Registered Y/ N j Fee Current I Y/ N j <br /> Address I <br /> 1 License # I <br /> OTHER <br /> Signature — e•-2.--1 I Company ' _ t7 „e .471,,,- Q, - 7 1.4e <br /> Address Registered MM. Fee Current CI <br /> .te License # • • <br /> Directions: Fill out a lication com lete��� <br /> J <br /> PP completely. <br /> ly,���. <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 h //a <br /> ( ttP� PPreiser.pascogov.com) <br />