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813•780 -0020 'City of.Zephyrhills Fire 'q/(0 y,5 / Fax - 813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name �i•� / l � � R ers Phone Number <br /> I 1 <br /> 0 i�� <br /> Owner's Address / fJ ' /42- J A ` ,/ W ., ! i !� 4 A Y►/ <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 1 <br /> Fee SimpleTitieholder Address I • <br /> � <br /> Job Address ,c3 4 1 �j F c <br /> ._ v am. Lot # <br /> Sub Division Parcel # <br /> �_n__ w <br /> LI Bio-Hazard Waste Storage - ANNUAL = Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum n Hood Installation <br /> 7 Emergency Generator < 30 kw FT LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw Ii LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> (ut Ewell l:Taj •i:u i <br /> prinkler 7 0 ❑ • n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System installations <br /> Hood Suppression Ej ❑ ❑ ❑ I I JJ Standpipes (Sprinkler Sys) <br /> I-I Fire Alarm Installation I-I Torch Roofing/Tar Kettle <br /> El Fire Pumps I Waste Tire Storage ANNUAL <br /> I - I Fire Works <br /> n Flammable Application- ANNUAL I I Valuation of Project <br /> I`) Fuel Tanks <br /> Q Other: I <br /> Contractor (- 1 r Company <br /> Signature Registered Y / N J Fee Current ' Y/ N J r <br /> Address I I License # <br /> I <br /> ELECTRICIAN Company <br /> Signature 1 Registered Y/ N j Fee Current I Y / N I <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N J Fee Current I Y / N <br /> Address I I ' License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N ] <br /> Address I I License # I <br /> OTHER <br /> Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I J <br /> License # <br /> Directions: <br /> • <br /> • <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 (httpJ /appraiser.pascogov.com) <br /> • <br />