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s�3aso-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> • Permit Application <br /> Date Received 2' ��- Z- 0 l( Phone Contact for Pertnit �' ���(o � 6 q <br /> Owner's Name oit e. — � �. �' Owners Phone Number � 7 g L 7� 7� <br /> Owner's Address Sc� ,3 y / ST T � -e �' <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � C <br /> Fee 5imple Titleholder Address <br /> Job Address �a ; ,�j R � 5 r ,J y/ K�/ � <br /> Lot # <br /> Sub Division Paroel # <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 Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale � <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ �y emi �n er ❑ � � � <br /> Sprinkler ❑ ❑ ❑ Recreational Bum � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations - - <br /> Hood Suppression � ❑ ❑ �i � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Z O O Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor Company �; CL F� hf.�../' �,7� <br /> i <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address , c9, 8 La.,,� p%, /�3 �{63� License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Cunent Y/ N <br /> Address License # <br /> Directions: � „ , . . . ' . <br /> Fill out application completely <br /> Owner & Contrector sign back of application, notarized (Or, copy of signed contrect 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 /> Altow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />