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8 ° -780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit I 11 I I I <br /> Owner's Name 1 ,/7x- f.d'✓es 4A,,l wit✓✓ 1 ' al-/G I Owner's Phone Number I 3 112 7, 1 (a 7 I <br /> Owner's Address 1 3/t 3 A✓as 7s, ,¢lAr ,z,74t% // Fe. I <br /> Fee Simple Titleholder Name I Titleholder Phone Number I 1 I I <br /> Fee Simple Titleholder Address I <br /> Job Address 1 Lot # I <br /> Sub Division I Parcel # I <br /> El 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 a 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 /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> rafTyl !Semis LIZI ma= <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm 0 ❑ ❑ ❑ I 1 El Sparklers <br /> Hood Cleaning 171 ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ® ❑ a ❑ 1 1 1 I Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> El Flammable Application- ANNUAL I 1 Valuation of Project <br /> Fuel Tanks <br /> Q Other: I I <br /> Contractor Company I <br /> Signature Registered Y / N 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N _I Fee Current I Y/ N <br /> Address I 1 License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N i <br /> Address I I License # I I <br /> OTHER Company caiwr,l 'rC ,ra co"...,..../7"" L LG <br /> Signature c. —s1 Registered MEM Fee Current MM. <br /> Address I I License # I 2##,r 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 />