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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 Permit Application Date Received 1 1 Phone Contact for Permit I 1 J 1 Owner's Name I .6.vOsr l " A c ' ' S 1 Owner's Phone Number VA" 1 ( NI- s 1 L ' — Owners Address I s - A1610 6,,,e-e- WZ V ^ 2 . `� f`. Fee Simple Titleholder Name I ! /3 I Titleholder Phone Number I I I Fee Simple Titleholder Address I Job Address ( Lot # Sub Division Parcel # I I El Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL 0 Controlled Bum n Hood Installation 0 Emergency Generator < 30 kw n LP /Natural Gas - Installation El Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL r y Semi I Other Sprinkler Ei ❑ ❑ ❑ n Recreational Bum Fire Alarm n ❑ ❑ ❑ I I n Sparklers Hood Cleaning ® ❑ ,I$( ❑ I I n Sprinkler System Installations Hood Suppression ® ❑ I ❑ I I n Standpipes (Sprinkler Sys) 0 Fire Alarm Installation n Torch Roofing/Tar Kettle El Fire Pumps n Waste Tire Storage ANNUAL R Fire Works Flammable Application- ANNUAL 1 I Valuation of Project 0 Fuel Tanks Q Other: I I Contractor Company Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I ELECTRICIAN Company Signature I Re Y/ N I Fee Current I Y/ N I Address 1 I License # I PLUMBER Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # MECHANICAL Company Signature Registered Y / N I Fee Current I Y/ N I Address I I License # OTHER Company rr /1 R — d - +sT 1Ld Signature }—f Registered Fee Current MEM Address I I License # 17P9 - S,e,c40 f9li 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)