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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 /> -mob <br /> Owner's Name J 1 c� 9 r! r . liCt LJ�' L S ! Ctn. ,e, h Owners Phone Number I 1 -= "I - ^ <br /> Owner's Address 1 `J 1 Po , 11, -7 I S c -.— <br /> Fee Simple Titleholder Name t �„ 1,1 11 S l c . ._.?..r3'5 Titleholder Phone Number I 1 1 I I <br /> Fee SimpleTitleholder Address I a <br /> Job Address a 0 -.r /30, S T CANK vC--L 1 Lot # <br /> e <br /> Sub Division if` 73 Se 1, 4, ," c ' A h. 1 /C Parcel # I <br /> Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> ED 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 n LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> ptrlyi )Semi) MI Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression Ej ❑ ❑ ❑ 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 /> n Fire Works <br /> n Flammable Application- ANNUAL <br /> FT Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor <br /> API Company v <br /> Signature Registered Y / N Agee' <br /> g i Fee Current I Y/ N J <br /> Address I License # I I <br /> ELECTRICIAN <br /> I Company <br /> Signature I <br /> Registered Y/ N f Fee Current I Y/ N j <br /> Address I I License #. I <br /> PLUMBER I Company <br /> Signature <br /> Registered I Y / N j Fee Current I Y/ N J <br /> Address I I ' License # I <br /> MECHANICAL' <br /> I Company <br /> Signature Registered l Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER I 1 Company <br /> Signature Registered I Y/ N I Fee Current I Y / N <br /> Address <br /> License # <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 h //a <br /> ( ttp: ppreiser.pascogov.com) <br />