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si3aao-oozo City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received Phone Contact for Pertnit �� Owner's Name Ovmers Phone Number �� Owner's Address Fee Simple Titleholder Name TiUeholder Phone Number �� Fee Simple Titleholder Address Job Address � � �p � • Lot # � Sub Division Paroel # � Bio-Hazard Waste Storege - ANNUAL � Fumigation Tent � Comm Exhaust Kitchen HoodlDuct � Hazardous Material (Tier II or RQ Facili UAL � � Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LP/Natural Gas-Installation -� � � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL S e 1 '7 � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUA �y em� �n er Sprinkler � ❑ ❑ ❑ � Recreational Bum Fire Alartn � ❑ ❑ ❑ � � Sparklers Hood Cleaning ❑ ❑ ❑� � Sprinkler System Instaliations Hood Suppression � � ❑� � Standpipes (Sprinkler Sys) � Fire Alartn Installation � Torch RoofinglTar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application- ANNUAL r Valuation of Project � Fuel Tanks Q Other: Contractor Company �•v i 7 Fj� �q��p..�,�, QGC Signature Registered / N Fee Current / N Address License # ��G s�000yrq9,� ELECTRICIAN Company Signature I Registered Y/ N Fee Current Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Current Y/ N Address License # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current 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 work 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)