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' 813 -780 -0020 City of.Zephyrhills Fire Fax - 813 - 780 -0021 <br /> Permit Application <br /> Date Received <br /> �. , _ . __.,,.• _...,,,.,- ... _:.- .,..,., ,•_a >,,. ,. .:.... ,.. .,,.; Phone Contact for Permit <br /> ,.. _ <br /> K ■ �� /W CV &O �3 � 5 1 9-6 � <br /> Owner's Name I �V� C-1 , Owner's Phone Number C_ <br /> � <br /> Owner's Address ��rlii`_ -,_ `% \ \I ' Cad 7q - 3 3 (-I <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Address I <br /> (� , ` <br /> Lob Address ) ' 3 �� mss- \ �� vi & z {��t i t \r\ , \\s 1 (� -- L 3 3 5 yr) Lot # <br /> Sub Division Parcel # <br /> n 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 /> Controlled Bum = Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale_ <br /> ^ <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly -AN AL <br /> IriFyl !Semi! Ma Other <br /> A � t <br /> CI ❑ ❑ = Recreational Bum 1 / ,� <br /> Fire Alarm ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ I n . Sprinkler Syste Installed <br /> Hood Suppression ❑ ❑ ❑ Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ' I Valuation of Project <br /> n Fuel Tanks <br /> ❑ Other. <br /> Contractor Company <br /> Signature Registered Y / N J Fee Current 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 #. <br /> PLUMBER Company <br /> Signature Registered Y / N _ Fee Current I Y / N j <br /> Address I ' License # <br /> MECHANICAL . Company <br /> Signature Registered Y / N Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER \�--t <br /> ,) Company <br /> Signature .�_ Registered Y/ N 1 Fee Current I Y/ N j <br /> Address \O S' Wk. r> 2 t . \\ - License # <br /> Directions: <br /> Fill out application completely. • <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> • <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 (littp: / /appraiser.pascogov.com) <br />