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_ 813 - 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 Permit Application Date Received I / I Phone Contact for Permit I I I I Owner's Name I jets'r ee..347d!'eAA/ v r e, I Owner's Phone Number Ira 117 1 7q Owners Address 1 5570 /9 - -SXee -67 z 4I.! /s f--Z. Fee Simple Titleholder Name I Titleholder Phone Number Fee Simple Titleholder Address I I Job Address I Lot # Sub Division I Parcel # I ED Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL El Controlled Bum n Hood Installation Emergency Generator < 30 kw n LP /Natural Gas - Installation n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL FirdiT1 ElEj Esj Other Sprinkler n ❑ ❑ ❑ n Recreational Bum Fire Alarm 0 ❑ ❑ ❑ I 1 E Sparklers Hood Cleaning 0 ❑ ❑ ❑ I I n Sprinkler System Installations Hood Suppression R ❑ x ❑ I I n Standpipes (Sprinkler Sys) El Fire Alarm Installation n Torch Roofing/Tar Kettle 9 Fire Pumps n Waste Tire Storage ANNUAL Fire Works E Flammable Application- ANNUAL ( 1 Valuation of Project Fuel Tanks Q Other: I I Contractor Company Signature Registered Y/ N I Fee Current I Y/ N J Address I I License # ELECTRICIAN Company Signature I Registered Y/ N I Fee Current I Y/ N J Address I I License # ( I PLUMBER Company I Signature Registered Y/ N I Fee Current 1 Y/ N I Address I I License # MECHANICAL Company Signature Registered Y/ N I Fee Current I Y/ N I Address I 1 License # I l OTHER Company creovr, 7 e --re` /.A y /4e Signature Registered ream Fee Current M *M Address ( License # `/igr/r,' /00 Zf�/' 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)