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813-780 -0020 City of Zephyrhills Fire <br /> Fax - 813 - 780.0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit I 1 1 1 <br /> Owner's Name I RA eaS 1 Owner's Phone Number <br /> Owner's Address 1 .3 y 7 ` j d - XL v,(� 2 y ,-L/ s FG. <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I I I I I <br /> Fee Simple Titleholder Address <br /> Job Address I i_,; <br /> Lot # I <br /> Sub Division ( Parcel # I <br /> D Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct = 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 /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ❑ r y Semi I 6,0 Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning ® ❑ I:i ❑ I I n Sprinkler System Installations <br /> Hood Suppression ® ❑ is ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> E Fire Works <br /> El Flammable Application- ANNUAL I I <br /> Valuation of Project <br /> r Fuel Tanks <br /> Q Other: <br /> Contractor <br /> Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I I <br /> ELECTRICIAN Company <br /> Signature I I Registered Y/ N J Fee Current I Y/ N J <br /> Address I .1 License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N J Fee Current I Y/ N <br /> Address I <br /> 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company iSeerr /7y ,/J 6e4, 7 2 <br /> Signature Registered Fee Current / N I <br /> Address 1 I License # <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 />