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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> PeRnit Application <br /> Date Received �--� Phone Contact for Pertnit �� �� � <br /> - , - ...., .. .. r_ . . .... �.:lr.» � .._. . .,. s . ., . , , <br /> Ovmer's Name p� Owner's Phone Number �„� [� �� <br /> ' 37 <br /> Owners Address � ,y � � � � G <br /> Fee Simple Titleholder Name Tideholder Phone Number ��� C� <br /> Fee Simple Titleholder Address <br /> . � , s.����:�;::�r �€�% - �s�$=.� a�.: -�.� a - G:�:� .•3"4Y:�9:>�4r . ����s'� ra:° ,.�� . <br /> �. ,:: . <br /> Job Address L �� <br /> Lot # <br /> Sub Division Paroel # <br /> . ., , . .. , �i.�+ , w.�°&t�-�°acp^=�c'33r�.t�a:s..��;>�azr,�a�.,�,s�b ;`s. ,. , w ... .. < _. .. � �s .... <br /> _: . . - , s-�,.: . ' . .,..,x <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent � � ' ' -w K , <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw a LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ (3FTr em� �n er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreationai Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ � ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ,1(1 ❑ �� � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Toroh Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> a Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> < .. , , c�; .� .. � ,. ,. -:r�.�.E�< .:fi<:m , . . � . . .. , , <br /> ' �- .` < a.:z"G'. .`«:d'". F�.Y�.�`.A?:aS�;:X::d?.iti�,... ''�k<'a::R'4Y�k:...rz.Y.' .. � . t <br /> Contractor <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature � Registered Y/ N Fee CurreM Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Curnent Y/ N <br /> Address License # <br /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company vr�7 ,Rc v psnew ,� C <br /> Signature Registered N Fee Current N <br /> Address License # <br /> DirecUons: . ,. .. .. . _ ., , _ ,. . _�..,.. �,... .<. - ,. , .. <br /> Fill out application completely. <br /> Owner 8 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 drewings with appiicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (httpJlappraiser.pascogov.com) <br />