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813-780-0020 City of.Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received - Phone Contac3 for Permit - <br /> Owner's Name AV 1 ik.k l (.5 / 1 fZGis A- F 1 Owner's Phone Number 1`g 1 1 7� � 1 71 g 7 <br /> J <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 I <br /> Job Address ; 1 J 's- it-, c- Lot # _ <br /> Sub Division I Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> a n Controlled Bum Hood Installation <br /> a Emergency Generator < 30 kw n LP/Natural Gas-Installation <br /> E Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Safe <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL / / <br /> disci (Serm1 raj Utner / <br /> Sprinkler El ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm E] ❑ ❑ ❑ I 1 I Sparklers <br /> Hood Cleaning ,� ❑ ❑ 1 I n Sprinkler System Installations <br /> Hood Suppression / ❑ ❑ J I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation <br /> Torch Roofing/Tar /Tar Kettle <br /> n 9 <br /> Fire Pumps I-I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> I—I Other: I I <br /> Contractor V i Company WIi / • <br /> Signature Re r�� ' ee Current MUM <br /> Address License # I 1 <br /> ELECTRICIAN Company r' I <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address I License # <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N <br /> Address I I License # ( I <br /> MECHANICAL Company ( <br /> Signature Registered Y / N I Fee Current 1 Y/ N 1 <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address License # <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 /> !b• 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 (httpj /appraiser.pascogov.com) <br />