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813-780-0020 City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> � Permit Application <br /> Date Received Phone Contact for Pertnit r_� <br /> Ovmer's p .�l�. <. . ..._. d.�.a �..._. , , . . .. , , , ,.. < ,z�. • . . . r d.� �, �,—,�J <br /> Name � � Owners Phone Number tl/3 7�-� ��Z <br /> Owner's Address .�'�jD�'j � �(�� z / �„�� / <br /> r� <br /> Fee Simple Titleholder Name � r� � <br /> TiUeholder Phone Number I <br /> Fee Simple Titleholder Address �—.–_ <br /> . ' � . . ... . .;�y,•y�A «rs F �`d9�� .[3�.,i:Y�. '��°h`�.1 n'4 . .�g ., . <br /> ' �.',_ :z' ,5 � :Ke"iz. , �, °Sm.'�.�.�,`«�'t.�t' , <br /> `:_ E' : .� .- . <br /> Job Address � <br /> Lot # <br /> Sub Division <br /> �, . ,., Paroel # <br /> .. �.�:�:.s�,� u�� �wa;�'rc�: s>» . <br /> � . . : . . .: � ,. .:>�.�es:;a ra;r:..:�z:u . �.a,r. .. . ,. ,z <br /> Bio-Hazard Waste Storage - ANNUAL � "'" ' ` �' • <br /> � Fumigation Tent <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-Instaliation <br /> a Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ � emi �n er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning �:JC �� ❑ ❑� � Sprinkler System Installations <br /> u <br /> Hood Suppression � y � ❑ � � �� ❑ <br /> a Standpipes (Sprinkler Sys) <br /> Fire Alartn Installation � Torch RoofingRar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammabte Application- ANNUAL <br /> Fuel Tanks <br /> Valuation of Project <br /> [� Other: <br /> .. , ... . ._ ...P>. �. , .:� --: �::�..� � :�_ . e , <br /> <:t�. ��>s::h�:�;...A., ��r,�,.�r .��,�K�:��,_�... . <br /> Contractor " ° ° °` ��;.� :�+u. <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> 5ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> 'LUMBER <br /> iignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> dECHANICA <br /> iignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> )THER <br /> '�ignature Company �v�,� c .� �� <br /> Registered N Fee Current / N <br /> Address <br /> License # <br /> irections: , ... , .. _.. . , .. ,. , � .. 7 S 4� ! 9 <br /> Fill out application completely. m �'"�' <br /> Ovmer 8 Contractor sign back of application, notarized (Or, copy of signed contrect with ovmer) <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 /> A�low 10-14 days for review after submittal date. <br /> Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />