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813 =780 -0020 City ofZephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> :»? 's5.. :'.^.. ass:", '. .::i.:,;&..cw.,...:»,..,�:::»us xaa.,..,.: u.uw....... .:.»u�..wma.....u..,: .:u„mrrfl v. w; ear. :- x:Ky .«...�. ..,: .;; .. ceve.. : -.e a�z ncs•awm- e.. • 'e..,,. r...n.nt.....�,�... ... .._M...w..:..�. I . <br /> Owner's Name Zditieyrh 4 4 f Owners Phone Number 44 I '7- I P// <br /> Owners Address s7 .20 ap . Ze. 'AD z 4 -Z //t <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholder Address I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> n B io -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas- Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas- ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> JQtriyl (SemiI rjj Other - <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning r ❑ M'1 ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ A ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> n F - ire Works <br /> n Flammable Application- ANNUAL I Valuation of Project <br /> n Fuel Tanks <br /> n O ther: I <br /> Contractor Company <br /> Signature Registered Y / N , Fee Current I Y/ N j <br /> Address ) I License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N I Fee Current I Y / N <br /> Address I I License #. <br /> PLUMBER Company <br /> Signature Registered Y / N _ Fee Current I Y/ N I • Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I License # I <br /> OTHER Company r12; .,� , , .. LGL <br /> Signature �s Registered N I Fee Current It/3 / N I <br /> Address <br /> License # ,y <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 />