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813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received I /#2 - ) "/D 1 Phone Contact for Permit 132 I 1 1 783 1 I /O 90 1 <br /> Owner's Name I [ti eV) ti \l I Owners Phone Number 1 1 1 I 1 <br /> Owners Address 1 5 65 (;. a l / /3 1 i/tri <br /> Fee Simple Titleholder Name I Titleholder Phone Number I 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address 1 w e A (4 J / s S 6,s c a. I 1 RI v 0 Lot # <br /> Sub Division I Parcel # I I <br /> 0 Bio- Hazard Waste Storage - ANNUAL Ii Fumigation Tent <br /> 0 Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I Hood Installation <br /> I --- I Emergency Generator < 30 kw = LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> 0 Fire Protection Maintenance - ANNUAL = Places of Assembly- ANNUAL <br /> r y ��J Other <br /> Sprinkler 0 ❑ ❑ ❑ 1 Recreational Bum <br /> Fire Alarm 1-I ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning I ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression El ❑ Ip ❑ I 1 I] Standpipes (Sprinkler Sys) <br /> I} Fire Alarm Installation I1 Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> 5 Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> 0 Fuel Tanks <br /> Q Other: <br /> Contractor � /, / � Company ■ L 0c4 7 4 F ' ^ 1 le . <br /> Signature I / L Registered r Fee Current [ jJ <br /> Address I 4 20 1 ins d r • M• 1 - ' FL _ , ?2 9S" 2 I License # I <br /> ELECTRICIAN Company I <br /> Signature 1 Registered Y / N 1 Fee Current f Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address I <br /> I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N J Fee Current 1 Y/ N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address I I License # I <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 />