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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> , • Permit Application <br /> Date Received - 7 Phone Contact for Permit <br /> . . , .,�� ,>._.=, .��...�.� .�_, , „ <br /> , . - s� ,s- .>. . ..�, r, � � - , . - <br /> Owner's Name S�C �� � J� Owner's Phone Number C� � C� <br /> Owner's Address �Q �j �� C /j'G t/� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> ., � ,,. ,;;»���:sw� ., <br /> � �_,�, ,�� �s» : <br /> � „cs�.ar <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> 5 � � .,. ' . _ .. �., , SP . _ "_�'�'w.x�'M' . .,ES+N'r» . s..rt <br /> _" a a.�,, .. .��, Ch,uL'. ^-m: � aqg?yger^+t"_'M. <br /> � Bio-Hazard Waste Storage - ANNUAL �� �Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct a Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Conirolled 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 a Places of Assembly-ANNUAL ��/ �K � <br /> ��y emi � er ❑ <br /> Sprinkler ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ O ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Othef: <br /> a � _. �� , ,.,.w.< rw ...��;�.�;�...,_ �-��� , . : � H �, �;,�,,���.� <br /> xwh �.TM.-;,k-.9�A`mUt����+�'a'#:-"3d?�:.iY4`�'w$+SJi!a-sta°r.-0";..'+- <br /> Contractor 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 <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> �THER <br /> Company <br /> 5ignature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> �irections: <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 submittai date Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />