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81378'0 -0020 City of.Zephyrhills Fire Fax-813-780-0021 <br /> • <br /> Permit Application <br /> Date Received L _ e <br /> Pho Contact for Permit <br /> 1 <br /> / r , 1 /V G <br /> Owner's Name �, 7 . ' / `� C re !J 71ms h /, t lr, Owners Phone Number <br /> Owners Address 383x3 / <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholder Address I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> I Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I—i Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ri Controlled Bum Hood Installation <br /> I - I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I — I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> 1Qtrlyl !Semi) Ma Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning [ ] ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ J I 7 Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I1 Torch Roofing/Tar Kettle <br /> I Fire Pumps Waste Tire Storage ANNUAL <br /> n Fire Works <br /> El Flammable Application- ANNUAL I Valuation of Project <br /> I — I Fuel Tanks <br /> El Other: I <br /> Contractor / Company <br /> Signature ` ' , T c Registered Y / N Fee Current 1 Y / N j <br /> Address I ( License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y / N . 1 Fee Current I Y/ N j <br /> Address I License #. I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I - License # ( I <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address <br /> License # <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 />