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sia-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> . . Permit Application <br /> Date Received Phone Contact for Pertnit �� � <br /> > � .. .r- �3. . . .. .. .__�.�.. ��.� «.. ,-z-..,�., <br /> Owner's Name L�lf '� 3/ Owner's Phone Number ��.3 ��o� I�4 <br /> Owner's Address ���`� (�J ir C �{ r •� L� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> , ... . ,._ - `aaa.tfi��a�:�=.« . - ..go; �MS,��,��..3a:'^�" <br /> Job Address � Lot # � <br /> Sub Division Paroel # <br /> � . x..,y , .;���=a , . . �a�-����^s=^a4-°-�a�-::..� _ s�aaa� �� . . <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Mate�al (Tier II or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> a 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 em� �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ O ❑ � � Sparklers <br /> Hood Cleaning � ❑ � ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ [�, ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL �--� Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> � r=�,.�� . �»�����,�F,- ¢ ,� �r� , :b�.�:�T•� �:.-:�:�-�a. <br /> . �� , �:� . ,�� <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 /> Address License # <br /> OTHER Company � r fi �.�t�t L�� <br /> Signature Registered Fee CuRent Y <br /> Address License # <br /> � ac� <br /> Directions: <br /> Fili 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 Mro (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 />