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813 - 780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received � <br /> �ast- Phone Contact for Permit I 1 I I <br /> k d .. Si- 9 Owner's Phone Number I 1 1 1 <br /> I <br /> Owners Name I -VO ��^�� 57�� / / <br /> Owners Address I Sa i c Q re/ 6 Ze24 /nil`s 1- 33 Cy) <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> Job Address I Lot # <br /> Sub Division I Parcel # I <br /> Bio- Hazard Waste Storage - ANNUAL = Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct iI Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum El Hood Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 7 Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL I Places of Assembly - ANNUAL <br /> ry Semi) !Other I ❑ <br /> Sprinkler I] ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm I I n Sparklers <br /> Hood Cleaning ® ❑ Y1 ❑ I I F Sprinkler System Installations <br /> Hood Suppression ® ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> II Fire Alarm Installation El Torch Roofing/Tar Kettle <br /> El Fire Pumps (l Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 I Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I ( <br /> OTHER Company . t i/7 Are. .q:• 7 • ,.r '1 A Le <br /> Signature Registered ` llindall Fee Current <br /> Address <br /> I I License # 1 7,pf y j <br /> S�c '/ G <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 />