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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 Permit Application Date Received I 1 Phone Contact for Permit I 1 1 1 1 Owner's Name 1 aa49?1-+.4,_, Owner's Phone Number I al - 1 17.2 I9n-z Owner's Address 1 4 a At Gi, -GL "XL V r) 2PpLyri6 i r ,L Fee Simple Titleholder Name I Titleholder Phone Number I I I Fee Simple Titleholder Address I Job Address Lot # Sub Division Parcel # n Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent 71 Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL 0 Controlled Bum I Hood Installation I — I Emergency Generator < 30 kw n LP /Natural Gas - Installation 0 Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale 0 Fire Protection Maintenance - ANNUAL El Places of Assembly - ANNUAL r rsgrnri Other Sprinkler E ❑ ❑ ❑ I-1 Recreational Bum Fire Alarm n ❑ ❑ ❑ I I n Sparklers Hood Cleaning 170 ❑ ❑ I I n Sprinkler System Installations Hood Suppression ❑ pie ❑ I 1 7 Standpipes (Sprinkler Sys) I -I F ire Alarm Installation v Ii Torch Roofing/Tar Kettle R Fire Pump n Waste Tire Storage ANNUAL Fire Works H Flammable Application- ANNUAL I ( Valuation of Project Fuel Tanks (l Other: I I Contractor Company I Signature Registered Y/ N J Fee Current I Y/ N I Address I I License # I I ELECTRICIAN Company I Signature I Registered Y/ N I Fee Current I Y/ N Address I I License # I I PLUMBER Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # 1 I MECHANICAL Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I I OTHER Company S je.ir7 7 A; re ea 6 7 Lid I Signature Registered �N Fee Current l( N I Address I I License # 1 7lla S�rnvo 9/99L 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)