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s�3aaaoo2o City of.Zephyrhills Fir:e ��/ �� Fax <br /> ' Pe it Application <br /> �ate Received '"'�T �y� L- ��//� Phone Contact for Permit�� �'�"�'( <br /> ta�a°,.4�:..:�s..°..::�,��:�....;......,.w..,....�..�... ° -� ,.�..,,._ `'' .__.�_ '� ...L_ _L�LJ <br /> .,. Y....,...,.z.,� . ._.>_�,.�c.....�, <br /> �wner's Name �� s� Z7'(f Owners Phone Number <br /> ,_ �� ��. `�' � <br /> �wner's Address � �. �x �i'7( ,;�T 33G' <br /> ee Simple Titleholder Name Titleholder Phone Number �� � <br /> =ee Simple Titiehoider Address <br /> � <br /> �.,� � ;�,�---__ <br /> ��':=' <br /> Job Address /r C ��T Gj"�j � � ��UD • Lot# �� <br /> Sub Division Parcel # <br /> a Bio-Hazard Waste Storege - ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Materiai (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generetor < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL a Places of Assembly-ANNUAL <br /> r y emi � er <br /> Sprinkler � O ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ O O�� � Sparklers <br /> Hood Cleaning � ❑ � ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑� a Standpipes (Sprinkler Sys) <br /> a Fire Alartn Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire 5torage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL �— Valuation of Project <br /> Q Fuei Tanks <br /> � Other• <br /> Contractor �,��.,� Company <br /> Signature �' '����� Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registe2d Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> Directions: ' <br /> FIII 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 afler submittal date. Parcel #- obtained from Property Tax Notice (http://app2iser.pascogov.com) <br />