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e�saso-oozo City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit ��� f � <br /> �_•__—J <br /> Owner's Name Owner's Phone Number � �� Q�, a <br /> Owner'sAddress p� � �� ��- 'S '� ►�/� � L � 1� � 5 � <br /> "' d <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � I I <br /> Fee Simple Titleholder Address �--�� <br /> Job Address C� `� � C� �} �iL, i7LV Q ���}� R-� 1 �-LS I L ��� � <br /> ) Lot # � <br /> Sub Division a � h (� / an q <br /> ' �oL.� Parcel# 3S `��S '�'l'v�.�l)'" �?�C?C�^' U/y0 <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 Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> a Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � y� Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL ,�� <br /> �� ❑ � emi � er ❑ � <br /> Spnnkler ❑ ❑ ❑ Recreational Bum � <br /> Fire Alarm � � � � t <br /> � � Sparklers <br /> Hood Cleaning ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation a Torch Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other• <br /> Contractor <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Signature COm ��y �' �� V�' � <br /> Registered Y/ N Fee Current Y/ N <br /> Address G, ` d Q � � v <br /> License # <br /> oirections: �+� .��� <br /> Fill out application completely <br /> Owner 8 Contractor sign back of application, notarized (Or, copy of signed cpntract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applipble documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Pro <br /> perty Tax Notice (http:!/appraiser.pascogov.com) <br />