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F513-780-0020 City of Zephyrhills Fire Fax - 813 - 780 -0021 Permit Application Date Received I ),9..-7011.7 _ 2 I Phone Contact for Permit I 6 3 1 I 1 --i75 --- 1 1 6ff I Owner's Name 1 Ch d/ /j r'$ I Owner's Phone Number I 1 1 I I Owner's Address 1 Fee Simple Titleholder Name I Titleholder Phone Number I Fee Simple Titleholder Address Job Address 1 7 ✓ -C I" / ✓JV t - 1 Lot # Sub Division Parcel # I I n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL 0 Controlled Bum = Hood Installation I Emergency Generator < 30 kw n LP /Natural Gas - Installation ,., ---�" Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale r n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL 76 UM LW Other Sprinkler Ej ❑ ❑ ❑ n Recreational Bum j 9 i Fire Alarm n ❑ ❑ ❑ I I n Sparklers Hood Cleaning 0 ❑ ❑ ❑ I 1 n Sprinkler System Installati s Hood Suppression IT ❑ K ❑ I I = Standpipes (Sprinkler Sys) Fire Alarm Installation n Torch Roofing/Tar Kettle H Fire Pumps n Waste Tire Storage ANNUAL Fire Works TI Flammable Application- ANNUAL 1 I Valuation of Project El Fuel Tanks Q Other: 1 I Contractor 1 Company re /114.,54 I Signatureil�r Registered Y/ N ] Fee Current I Y/ N I Address 1 4f7U( 69 • I License # / 1 16: ,. .3g1 VW / c9O Cr I ELECTRICIAN Company I Signature 1 Registered Y/ N I Fee Current I Y/ N J Address I I License # I I PLUMBER Company I Signature Registered Y/ N 1 Fee Current I Y/ N f Address I I License # I I MECHANICAL Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I I OTHER Company I Signature Registered Y/ N ] Fee Current I Y/ N I Address I I License # I I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)