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813-780-0020 City of.Zephyrhills Fire Fax- 813780 -0021 <br /> Permit Application <br /> Date Received <br /> .< w;. s?!: i.' �."." �.:! i,- s' �r' �`" �' S.'."` �" z: L" �v.,.,. w�, su»'; .,a,✓ra.5xw:.,.:..+:.:,:«,,,w4tt .,- � ddR,�z. :,::... - ,.•, -, ' °" w, e .. �,e`.+ `�+.ec�,ch��• ab <br /> Phone Contact for Permit I I <br /> Owner's Name 1 4-L,g9/{ o.',47‘.4 ,y,-( �Fs '�vey - -� / Owner's Phone Number 1 r3 7 2 9 - <br /> Owner's Address 2 /L/ -3 1_�' z 4`A,// ,( . <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple 'Titleholder Address I <br /> ....r✓'.. :°•.'� . >� , n�,..r ,, ,3-'- ;rte -. . :,-?:' •..... h ,. ..':•rk: „saS:i °�_.. I <br /> Job Address 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 II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IQ em <br /> trlyl i Other <br /> Sprinkler n 0 0 ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I ( n Sparklers <br /> Hood Cleaning JJ ❑ ❑ ❑ f I n Sprinkler System Installations <br /> Hood Suppression ® ❑ ' ❑ I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> E Fire Works <br /> n Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> Contractor Company <br /> Signature Registered Y/ N J Fee Current I Y / N J <br /> Address I <br /> License # <br /> ELECTRICIAN Company <br /> Signature 1 Registered Y/ N J Fee Current I Y/ N <br /> Address 1 I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N J <br /> Address I <br /> 1 License* I <br /> MECHANICAL Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I <br /> 1 License # <br /> OTHER Company Wevi 1 � x6 eavprnrs%N L L �- <br /> / <br /> Signature —� r <br /> r� -s/� Registered mini Fee Current MCI <br /> Address License # ib C30 / `t <br /> r .mow <br /> . >_,: b, ...: .. .: .,�`� &c..s�.:„A'aa "'� <br /> Directions: -• -• ,e -. _ . ..�_�<_ ..._ b __.. <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 />