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813- 780-0020 City of Zephyrhills Fire 1 16938 Fax -813- 780 -0021 Permit Application Date Received `lliff'rnallin Phone Contact for Permit 11- 1-7- 119LI Z 1 I l g Q3 I Owner's Name Mii I • • 2QQ-� � / r - 9 Owner's Phone Number I 1 1 1 I Owner's Address I / V? O /re N �r y . �f Z't° /! yik7/S / JS / d 11 Fee Simple Titleholder Name I / i ' Titleholder Phone Number I I I I I Fee Simple Titleholder Address - 1 3 )� ffen,/ �If Job Address y Sub Division ( � �/ � ?.3 S/ � Lot # I Parcel # I Bio- Hazard Waste Storage - ANNUAL El n Hazardous Material (Tier II or RQ Facility) ANNUAL Comm Exhaust Kitchen Hood /Duct Hood Installation n C Burn ED LP /Natural Gas - Installation 0 Emergency Generator < 30 kw ED LP /Natural Gas - ANNUAL Sale E Emergency Generator > 30 kw t IX I I Places of Assembly- ANNUAL Fire Protection Maintenance - ANNUAL �� Recreational Burn I Qtrl Y� � I " "' I (Other I Sprinkler �( ❑ ❑ j I - 1 ]� L _ j Sparklers S i © Fire Alarm a ❑ ❑ ❑ I I I I Sprinkler System Installations Hood Cleaning 0 ❑ ❑ I I I p VI El (Sprinkler Sys) -t Hood Suppression ❑ ❑ ❑ [ I I I Torch Roofing /Tar Kettle t l Fire Alarm Installation I= Waste Tire Storage ANNUAL I I Fire Pumps r - i Fire Works 7 Flammable Application- ANNUAL J Fuel Tanks Valuation of Project Q Other: I I Contractor Signature .1 4 - 41. i . Company I A To 1 3a64io I Registered Y/ N Fee Current j Y/ N I Address 3531 110154.one. I License # I9g 3531/ 0001A002, I ELECTRICIAN' I Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I I PLUMBER I Signature I i Company Registered Y/ N I Fee Current I Y / N I Address I I I License # I MECHANICAL' Signature Company I Registered Y/ N j Fee Current I Y/ N I Address 1 License # I I OTHER j Signature I i Company I Registered Y/ N j Fee Current I Y/ N I i Address Directions: License # Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)