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813- 780 -0020 <br /> City of Zephyrhills Fire 4V0 001)b Fax - 813 - 780 - 0021 <br /> Permit Application <br /> Date Received ��� L Phone Contact for Permit Ewa n fi 7 IP o 7 <br /> Owner's Name ' �'( �L/f7 Gf � l l / f ( m <br /> Owner's Phone Number I 1 1 I f <br /> i <br /> Owner's Address 71/5 G'L 'd ""L-?:� // i /j: <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address <br /> Job Address <br /> '7 Q0 /p'd • . /�/- 1. /J /i J Lot # <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Burn 171 LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> n Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> ❑ r y er. ga Other <br /> Sprinkler ❑ ❑ ❑ n Sparklers <br /> Fire Alarm 1 ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ I I n Torch Roofing/Tar Kettle <br /> I Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> F Fire Works <br /> Ii Flammable Application- ANNUAL 1 /7S0 <br /> , t I Valuation of Project <br /> n Fuel Tanks <br /> I Other: 1 I <br /> Contractor Company I <br /> Signature Registered _ Y/ N I Fee Current I Y/ N I <br /> Address I • I License # ( I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address 1 I License # ( 4 <br /> PLUMBER � / Company /(1 77 /�a� C <br /> .c� �/ R egistered f Y N Fee Current I / N <br /> Signature ` p k i� <br /> Address .: d.,� rL� / ! /i,� /.:ii/�g�i�1Jit./ m�r License # I'�r�"j llSl j ,cj I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> Directions: <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 />