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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> ,,. : - b . , ,�--; . �..���,..�>. » -.. . . y . -,� <br /> - ��.r,...,r., u_ � <.� < . , . <br /> Owner's Name � 7 Ovmer's Phone Number �� � �'(� <br /> Owner's Address � �s � i� � l< <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> . _ > -�-,��, �rt _ .. ""�".�':e"::><t_ . ;�?aRqmen^:�✓r.:�,�-;�;��Y� <br /> Job Address � <br /> Lot # <br /> Sub Division Parcel # <br /> . , � �:�n;�k:; -- - . . +'�-��'nr:e^i�'e�.'s���'.2°"'y .s. e- _ ,na�.�q�'Fr,s.'m^.� os� , . ±:n.��!' - _. , . . . _ . <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <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 � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning ❑ ❑ �� � Sprinkler System Installations <br /> Hood Suppression ❑ � ❑ � � Standpipes (Sprinkler Sys) <br /> a Fire Alarm Installation � Torch 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 /> � . v:�x'ti+:i" .. ..e�..e._4>�'? _ .' . _ :. _'�. n_ "1ft"5� �t.€..".:6_' . ._� . _ .'�'#a.-�.$I??.}:Sk <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 Current Y/ N <br /> Address License # <br /> PLUMBER <br /> 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 n 7,�iiG �u� r-,..,� LG L' <br /> Signature Registered / N Fee Current 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 />