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813-780-0020 City of Zephyrhills Fire Fax-813-780.0021 , Permit Application Date Received �-� Phone Contact for Pertnit �� Owner's Name � � �.+ZQI'Zl/� � -'� �--� Owner's Phone Number �� Owner's Address � ��J �l ` � +� S � Fee Simple Titleholder Name Titleholder Phone Number �� Fee Simple Titlehoider Address �. . F:,a,a s, Job Address Lot # � Sub Division Parcel # � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LP/Natural Gas-Installation � Emergency Generator> 30 kw � LPMatural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL Places of Assembly-ANNUAL �y emi � er Sprinkler � ❑ ❑ ❑ � Recreational Bum Fire Alarm � ❑ ❑ ❑ � � Sparklers Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations �J �-1 � � Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) (� I � Fire Alarm Installation � Torch RoofinglTar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Appiication- ANNUAL �-� Valuation of Project � Fuel Tanks Q Other: Contractor [`-�--��- Company Signature � " Registered Y/ N Fee Current Y/ N Address License # ELECTRICIAN Company Signature � Registered Y/ N Fee Current Y/ N Address License # PIUMBER Company Signature Registered Y/ N Fee Current Y/ N Address License # MECHANICA Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Cument Y/ N Address License # Directions: Fill out application completely Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical woric over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com)