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813-780-0020 City of Zephyrhills Fire <br /> Fax-813-780.0021 <br /> Permit Application <br /> Date Received <br /> "'. ^:" ,° . Phone Contact for Permit � <br /> ,, . - �.�aa.:�x ��ma. .�a:t �+��ar.��-n�:�a <br /> Owner's Name c/ � <br /> Ovmers Phone Number p <br /> Owner's Address �' G / <br /> I <br /> Fee Simple Titleholder Name �"� �� �� <br /> Titleholder Phone Number _ J <br /> Fee Simple Titleholder Address <br /> r -e ,. � ��� ;_ ,. , , m m:� - <br /> Job Address �� <br /> Lot # <br /> Sub Division <br /> n,,.: �.:---.�;=ti . Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � � " <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen HoodlDuct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum Hood Installation <br /> � Emergency Generator < 30 kw � <br /> � LP/Natural Gas-Installation <br /> Emergency Generator > 30 kw � <br /> � LP/Natural Gas-ANNUAL Sale , <br /> Fire Protection Maintenance - ANNUAL � � <br /> Places of Assembly-ANNUAL <br /> ❑ � emi �n er <br /> Sprinkler � � � ❑ <br /> Recreational Bum <br /> Fire Alarm � p � � �� ❑ <br /> ❑ Sparklers <br /> Hood Cleaning p � � ��I ❑ <br /> PP � ❑ � � ❑ Sprinkler System Installations <br /> Hood Su ression � <br /> � Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � FlammableApplication-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> : ..�.�,� � _,..�.:�� :; .a, � ,.��;:�:+�,��� � <br /> � ��° ,,.��s��:�;. ��-,:,-�; a:��- ..�;,,��,�.�� <br /> :ontractor ��3 °��^��:��,. , <br /> � <br /> �ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> LECTRICIAN License # <br /> ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> LUMBER <br /> gnature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> ECHANICAL License # <br /> gnature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> "HER � <br /> �nature Company ' QG <br /> Re istered L " <br /> Address <br /> 9� Fee Current Y N <br /> ections: License # 0 � � <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 htt //a <br /> � P� ppreiser.pascogov.com) <br />