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813-780 -0020 City of Zephyrhills Fire <br /> Fax- 813 - 780.0021 <br /> Permit Application <br /> Date Received I I I 1 1 I I <br /> Owner's Name I ( iit!/9' S rthe I <br /> Phone Contact for Permit <br /> Owners Phone Number I I 1 1 <br /> Owner's Address I ?9y0 a4-44 T$ 'D 2 14 itrz. <br /> Fee Simple Titleholder Name I I I I 1 1 1 <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address <br /> I 1 Lot # I <br /> Sub Division 1 Parcel # I <br /> Bio- Hazard Waste Storage - ANNUAL <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Ell Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> n Emergency Generator < 30 kw a LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw ED LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL <br /> Places of Assembly- ANNUAL <br /> El ry �Semij WI 'Other I <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I <br /> Sparklers <br /> Hood Cleaning % ❑ ❑ I I <br /> Sprinkler System Installations <br /> Hood Suppression N ❑ ` ` ❑ I I n Standpipes (Sprinkler Sys) <br /> a Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> a Fire Pumps El Waste Tire Storage ANNUAL <br /> n Fire Works <br /> El Flammable Application- ANNUAL I I <br /> n Valuation of Project <br /> Fuel Tanks <br /> Q Other. I <br /> Contractor <br /> I Company <br /> Signature <br /> I Registered Y / N J Fee Current I Y/ N I <br /> Address I <br /> I License # <br /> ELECTRICIAN <br /> Signature I I Company <br /> Registered Y/ N j Fee Current 1 Y/ N <br /> Address I <br /> 1 License # I <br /> PLUMBER I <br /> I Com pany Signature <br /> Registered Y/ N I F ee Current I Y/ N <br /> Address I I <br /> I License # <br /> MECHANICAL' <br /> I Company <br /> Signature <br /> Registered ¥ / N_1 Fee Current I Y/ N <br /> Address I <br /> I License # I <br /> OTHER <br /> Company <br /> Signature e/# /�'C 67e A../7' L LCD <br /> Registered MEI Fee Current O&M <br /> Address I <br /> it ., <br /> 1 License # I Z>,94 S' , 1 0 470 f f <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 />