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V3-780-0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> /� <br /> Permit Application <br /> Date Received I Ig — 7 / U 1 Phone Contact for Permit I 1.1 1 .I <br /> Owner's Name t... ev Ad Zoi/ !i✓G� Owner's Phone Number 1 1 1 / 119 ` <br /> Owner's Address 1'.Z'O /c ' s12eier - <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> Job Address Lot # <br /> Sub Division Parcel # I I <br /> 0 Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> F - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ry !Semi' LW Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm 0 ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning L Ac.t ❑ ❑ gid I n Sprinkler System Installations <br /> Hood Suppression ® ❑ X ❑ l I n Standpipes (Sprinkler Sys) <br /> Q Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> El Flammable Application- ANNUAL <br /> 1 1 Valuation of Project <br /> I - 1 Fuel Tanks <br /> 0 Other. <br /> Contractor Company 1 <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N 1 Fee Current 1 Y/ N <br /> Address I 1 License # I 1 <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current ( Y / N <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I 1 License # 1 <br /> OTHER Company sPADiv 4' Are e Qu .►. s./7 L G C I <br /> Signature Registered _ N I Fee Current I N 1 <br /> Address 1 ( License # 1 2 if467- 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 />