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813-780-0020 Ciry of Zephyrhills Fire <br /> Fax-813-780.0021 <br /> Permit Application <br /> Date Received '' <br /> � � � - .. Phone Contact for Pertnit _� � � <br /> .. . _d.,..�..;..::. -= � . , , <br /> Owners Name � Ze ,� Owners Phone Number �� r_� <br /> Owners Address <br /> L <br /> Fee Simple Titleholder Name �� �� �� <br /> Titfeholder Phone Number <br /> Fee Simple Titleholder Address <br /> �*� - �<:>�;�.�b... . <br /> J � ..� . ... <br /> Job Address D � '`_�"�`� q�n�^s�:s:�:k;�.:��,�:�= <br /> G� / (� �v b <br /> Lot # � <br /> Sub Division <br /> - . Parcel # <br /> , • , r.I:.E'f°4.ac°�xT°F.:F"%:'#F.qr.'�"°„�i'-!7'3.°�'.'3a✓'d'.w'*.'9ir8!ts,r#>F�. <br /> � ,. _ . . .. •� cG,'r�•._' .: � � s. ,.. .... :.x:�.ur>J'-.s_.,.. <br /> Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct Hazardous Material <br /> � (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instailation <br /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ � emi � er <br /> Sprinkler p ❑ ❑ � Recreational Bum <br /> Firoe Alarm � p ❑ O�� � Sparklers <br /> Hood Cleaning � p � � <br /> � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ � ��� � Standpipes (Sprinkler Sys) � y � <br /> . � Fire Alarm Installation � Torch RoofinglTar Kettle ��� <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> Fuel Tanks <br /> Valuation of Project <br /> [� Other: <br /> y .,.,�; ;��,:�,:. .. ,,,}, <.:.�.�_�:.._:�.:�:.- �. �....,,..,,. - <br /> ��-:� .� LL. , � _ , . , <br /> Contractor ...� " ' . . »w,., .. :;:�::;b:�.��� .�:�.: .,�.�+� ��s�,�.•.� �x�:> <br /> '" <br /> Signature Company � Q S <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # �— <br /> PLUMBER <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> MECHANICAL License # <br /> 5ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> )THER <br /> �ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> s "' ''"� ` - - License # <br /> )irections: - - ,. . . , . �. ...�, . .k... . .. ..� ,. , .. . ... , .. .. <br /> Fill out application completely. ' � ` �� Q ����� M . ", � .` . . , " .";`�"" <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. <br /> Parcel #- obtained from Property Tax Notice (httpJ/appraiser.pascogov.com) <br />