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813-780-0020 City of.Zephyrhills Fire i'j2 1 I I V 0 Fax -813- 780 -0021 <br /> Permit Application - Date Received. b / / Q Phone Contact for Permit <br /> 7a7 <br /> Owner' s Name Z2ph 9.rh i 1 i I s rn nS Ci ) b Owner's 2 Phone Number ' i3 738 , y /Qca <br /> Owner's Address 38L45 <br /> ` J t'► I ( / X <br /> I,V.. 2 Q1) 1 Jr h I I i I 5. <br /> - -- 5('7 [ c <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> b � ,;�s <br /> Job Address 3$5 V h QV Z-Q-hc (t S F 1 3309,2 Lot# <br /> Sub Division Parcel # <br /> I I Bio-Hazard Waste Storage — ANNUAL n Fumigation Tent , <br /> I I Comm Exhaust Kitchen Hood /Duct r ---, Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL r I I Places of Assembly- ANNUAL <br /> [witil9 ISemiI 1""' I Uther <br /> Sprinkler T1 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ X I n Sparklers <br /> Hood Cleaning II ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps in Waste Tire Storage ANNUAL <br /> Fire Works <br /> I_ I Flammable Application- ANNUAL ) ( Valuation of Project <br /> Fuel Tanks <br /> Othe - I I <br /> IIM, R egistered Y / N F e , y , L <br /> Contractor Co mpany ,5884 � Quiz_ ) �yrl l ib ff i <br /> Signature ,�� .'�,� �t' 1 I a Current Y N a <br /> Address f ( License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N j Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address • 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 />