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813 -780 -0020 City of Zephyrhills Fire 1 ,/ Fax- 813- 780 -0021 <br /> Permit Application (/ <br /> Date Received I 1--S l l <br /> 1 Phone Contact for Permit I % 1 1 LIZ ° 116 "-1 <br /> Owner's Name U il•+- it, S GRL L-- ,- vrrum, I Owner's Phone Number I t i 1 1 i ' 1 1 ' ' <br /> Owners Address illat t -1 L tP el& °`t- D ? L ''rA,-.Pt- 41- 1.3 t Z \-( <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address l' 2 Z O 1 L. A - I) it- (•,/ <br /> 1 Lot # <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 /> n Controlled Bum n Hood Installation <br /> El 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 11 Places of Assembly- ANNUAL <br /> ITIFyl perrili ma mom <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ I I 0 Sparklers <br /> Hood Cleaning ❑ [ ❑ I l n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps Il Waste Tire Storage ANNUAL <br /> n Fire Works <br /> E Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> ✓I Other: c- x l+ C l a or-- • "' <br /> Contractor - f' <br /> Company J.IJt? S,• STEicb■ Cl.o -'A'}---) <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # 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 />