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a�3-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received � Z t� Z O� Phone Contact for Pertnit $/ 3 99 6 6 y6 <br /> � . . <br /> Owner's Name ,e,n��e. �.o nn,dt�v d� 5 Owners Phone Number ��� <br /> Owner's Address S 1 c7 ('c.�'}- O r� �CJ� 3 3 S� v <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> , . , . ��.,,:� - ,,, <br /> Job Address ...scc, W�— Lot # � <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum o Hood Installation <br /> � Emergency Generator < 30 kw � LP/Naturai Gas-installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale I'/�� <br /> � Fire Protection Maintenance - ANNUAL � Piaces of Assembly-ANNUAL /� <br /> �y em� �n er � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� a Sprinkler System Installations <br /> Hood Suppression � � ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Wo►ks <br /> � Flammable Application- ANNUAL rp� Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor �� Company —J'i`!`L -�i G� - f�!' /�'t � <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address ,D , a fj � (�H � v'(� 6,3 License # <br /> ELECTRICIAN Company <br /> Signature � 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 /> MECHANICA 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 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 Mro (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appreiser.pascogov.com) <br />