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R13 -780 -0020 City of.Zephyrhills Fire Fax - 813780 -0021 <br /> 'Permit Application <br /> Date Received <br /> .. )J?ID Phone Contact for Permit <br /> Owner's Name ✓! r; U� Jj V e. ,'o �li Owners Phone Number I c /, j I I , 1 1 9)22 <br /> Owners Address ' /) ,es q l Pi,. G€, le,,, / <br /> -r / F�lj 33X37 <br /> Fee Simple Titleholder Name Titleholder Phone Number I I I l <br /> Fee Simple Address I <br /> Job Address Ai c_ L �f(/✓- _ 42,5 _ �O /� !# `} /� D/ Arlli,/Y ! Lot* f <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct <br /> • <br /> n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum = Hood Installation <br /> Li Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire- ction Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ❑ IUtriyl 'Serail 7 ether <br /> Sprinkler ❑ .❑ n Recreational Bum <br /> ire Alarm E ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I n Sprinkler System Installations <br /> Hood Suppression = ❑ ❑ ❑ <br /> Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL Valuation of Project <br /> n Fuel Tanks <br /> Q Other <br /> Contractor / 4# , Company GO / yC i� / Signature , . J _ Registered Y / N Fee Current Y / N <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature I Registered I Y / N, Fee Current I Y/ N j <br /> Address I I License #. I I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current I Y / N j <br /> Address I ' License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N _I Fee Current I Y/ N <br /> Address I I License # I <br /> OTHER Company <br /> Signature <br /> Registered Y/ N J Fee Current I Y/ N j <br /> Address License # <br /> .. <br /> Directions: <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 (littp: / /appraiser.pascogov.com) <br />