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813 - 780 -0020 City of.Zephyrhills Fire Fax-813-780-0021 <br /> - Permit Application • <br /> Date Received <br /> Phone Contact for Permit <br /> Owner's Name 1p*bey 102 61 "a Owner's Phone Number f/3 cr'"0 Fx <br /> Owner's Address _379.145 /r iebeA- - AQZ 0 V ' 7 ,0A/rx, /4 ,L <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholder Address I <br /> Job Address Lot* <br /> Sub Division Parcel # <br /> Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> FT Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL (t l 7 <br /> 1Qtrlyl 1Semil Fri Uther <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ )1( ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch RoofingfTar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> J I Flammable Application- ANNUAL ` ( Valuation of Project <br /> Fuel Tanks <br /> n Other: 1 <br /> Contractor Company <br /> Signature Registered Y / N 1 Fee Current I Y / N J <br /> Address I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N J <br /> Address I 1 License # <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y/ N J <br /> Address I License # 1 <br /> MECHANICAL Company <br /> Signature Registered Y/ N J Fee Current I Y / N I <br /> Address 1 License # I <br /> OTHER Company 490--rlt F• W /yir,./7 [GC <br /> Signature Registered W' Fee Current macs <br /> Address I License # .4=0 i 1 05//9Jr' <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 />