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s�saso-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> , Permit Application <br /> Date Received i � 3- � g `�� Phone Contact for Pertnit � 3 N�� S�3 q <br /> Owner's Name �o�da�v. Q�� Ovmer's Phone Number gt 7 j �� �S�J`� <br /> Owner 'sAddress 3Z `� �s �i� la� � ��✓Q 3'3S-f 2 <br /> Fee Simple Titleholder Name TiUeholder Phone Number ��� <br /> Fee Simple Titleholder Address <br /> . �.. . _ . <br /> Job Address 4 � / � " ' `� Lot # � <br /> Sub Division Paroel # <br /> � BiaHazard Waste Storage - ANNUAL � FumigaGon Tent <br /> � Comm Exhaust Kitchen HoodlDuct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> a Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Naturai Gas-InstallaUo� <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 � ❑ ❑ O � Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkier System Installations <br /> Hood Suppression � ❑ ❑ � � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Toroh Roofing/7ar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL ,� O Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> Co�tractor Company 1Cr rc. Fi ( ..t <br /> Signature Registered N Fee Current N <br /> Address . o� p � ,� 63 License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered 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 License # <br /> Directions: <br /> Fill 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 after submittal date. Parcel #- obtained from Property Tax Notice (http:!/appraiser.pascogov.com) <br />