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813 - 730 -002o City of Zephyrhills Fire <br /> Fax -813- 780 -0021 <br /> i. <br /> Y Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name I _ ^- I Owner's Phone Number ISM 11 I ... <br /> Owner's Address r 3 y/ zZe <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 11 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address I I I <br /> Lot # <br /> Sub Division Parcel # I I <br /> pi <br /> Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> JJ Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n E mergency Generator > 30 kw n LP/ atural Gas - ANNUAL Sale <br /> n F - ire Protection Maintenance - ANNUAL laces of Assembly- ANNUAL <br /> IQtrlyl !Semi lam Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ ( ( n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ ( ( LJ Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n F ire Pumps n Waste Tire Storage ANNUAL <br /> n F - ire Works <br /> n Flammable Application- ANNUAL ' <br /> n Valuation of Project <br /> Fuel Tanks <br /> n Other. I <br /> Contractor / �_ <br /> 6 �y Company <br /> Signature ' J 2 I Registered Y/ N 1 Fee Curent Y/ N <br /> Address I ( I <br /> License # <br /> ELECTRICIAN ' Company <br /> Signature I Registered Y/ N J Fee Current I Y/ N I I <br /> Address ( 1 <br /> License # <br /> PLUMBER I I Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N 1 <br /> Address ( I <br /> License # <br /> MECHANICAL' <br /> I Company <br /> Signature Registered Y/ N I Fee Current I Y / N I I <br /> Address I I License # <br /> OTHER I <br /> I Company <br /> Signature <br /> Registered Y / N J Fee Current Y / <br /> Address 1 I N <br /> >,�.��,K w.> . xi License # <br /> Directions: sre; ,,,�;tasxaua .. .; �;a:m�> :ew: r w.v«wz .s° - 3 < <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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />