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Ci of Zephyrhills Fire Fax-813-780-0021 <br /> a� 3-780-0020 � <br /> Permit Application <br /> ate Received Phone Contact for Permit <br /> a _ r:...�va,�:�,���_._ x. .. r�.� r,.� . ,� . <br /> �wner's Name 'll/� ✓ v. V �'�i i/✓� Owe�ers Phone Number � � ��O <br /> nnmer's Address Z-`P v' � S�r�� � � � S �� <br /> ee Simple Titleholder Name Titleholder Phone Number �� �� � <br /> ee Simple Titleholder Address <br /> ;;�a;��,r. �=t�s�;-r�'.. <br /> � .. ��. ,��«�„�, ,:,r- -;��� �� <br /> Lot # <br /> ob Address <br /> iub Division Parcel # <br /> x ., . -.=� � ����;���..� .. <br /> , . ��T.�,�:. $,���f� *� � <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> a Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � lP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL Q Places of Assembly-ANNUAL <br /> ❑ � emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ � � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ � � � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation a Toroh Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storege ANNUAL <br /> a Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Othef: <br /> � _,� �,.�..���.��.���a��.� _ ��:� , •����.��:�-.,.��. ��.�� <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 License # <br /> PLUMBER 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 /> Addre..s License # <br /> OTHER Company (/✓'l �r� <br /> Signature — Registered Fee Current / <br /> Address License # (o l <br /> r <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 />