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813-780-�020 City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Pertnit <br /> . ....... . .��r.. , . _ <��...� <br /> �, m, , ; , .. ., a. ; <br /> Owner's Name Zq< L <br /> Owner's Phone Number f 3 7/ S"" � S— v <br /> Owner's Address 3 d(� �a,c h E 7 � r �� �. <br /> Fee Simple Titleholder Name TiUeho�der Phone Number ��� <br /> Fee Simple Titleholder Address J <br /> . , � r.:�r�;� >�s.�: s�� �s�����*� ::_ � - <br /> x'• ,<, � •�-�.3z'� <br /> "�.�i.��,xs �.:� ra* o . ; � . <br /> Job Address � _�� <br /> Lot # <br /> Sub Division Paroel # <br /> , , v r $ ��rs �x�;-��-�* .x.� ��.s ,:r-��;.�,,� �3:� ;,. .� _ _ . <br /> � � ., .��:, x ;. .:s p .,..,, 3 . . , ,.,,. w�.x,< <br /> Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent r <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Instaliation <br /> � Emergency Generator < 30 kw � LPlNatural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ �Tr, emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ C� � Sparklers <br /> Hood Cleaning �❑ (� ❑� � Sprinkler System Installations <br /> Hood Suppression p <br /> � � � � � Standpipes (Sprinkler Sys) <br /> Fire Alartn Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> • � _. . . . � - . � ..-:�.: ,. � , .:�.--*s«��r .. .. . - . � <br /> Contractor . b � . .. . : �<�, �...,.a�;-. �,�,� �;+�r�K°� 9. . F . .. �a:�. <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Signature I 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 /> License # <br /> MECHANICA <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER � <br /> Signature � Company '��, � � c <br /> Registered N Fee Current N <br /> Address <br /> '.� - License # 7�� ��,r�y/�q �1 <br /> �irections: ' � . • � • . � , .• . . � <br /> Ftli out application completely. � ' i � <br /> Ovmer & 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 />