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813 - 780 -0020 City of Zephyrhills Fire Fax - 813780 -0021 <br /> Permit Application <br /> Date Received J Phone Contact for Permit � I <br /> Owner's Name 1 Ci,eE > 46 / I Owner's Phone Number 3-73 9 003S <br /> Owner's Address r'Y' 7 .-- .y -r.vy „ .0a. / , //s FL. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> El 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 I I Hood Installation <br /> n Emergency Generator < 30 kw n 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 /> I utriy I I Sem i t laLll Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning ® ❑ Cif ❑ I I n Sprinkler System Installations <br /> Hood Suppression © ❑ )4 ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Ti Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> Contractor Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y / N I Fee Current I Y / N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current Y/ N I <br /> Address I I License # I <br /> OTHER ._ SeT'uvi 7 � e i4;a.,� <br /> ,,,,, <br /> ,,,., L <br /> Signature °' ,---1 Registered pezal Fee Current MEM <br /> Address /1330 J4 ,- -,1r? - . i , e C. 7 .<< 3 352 (1 License # • G do % /fir' 6 <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 />