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e�a-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received . �2, �{— (1 � Phone Contact for Permit � 9 Q 6 �i �O <br /> � <br /> Owner's Name �� ti ��'�� �� Owners Phone Number � 7$ �� <br /> Owner's Address ( a.�l �`J � Z. � 3 S� ( <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> Job Address �J �1/�.� ' Lot # � <br /> Sub Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator> 30 kw � LP/Natural Gas-ANNUAL Sale ��3 � <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL � <br /> �y emi �n er n � � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum ! / ,� <br /> � v <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Toroh Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> a Fire Works <br /> � Flammable Application- ANNUAL Q — Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> Contractor Company ��rG � �{C/' /l L <br /> Signature Registered Y/ N F Current Y/ N <br /> Address ,a . fl $ � License# <br /> ELECTRICIAN Company <br /> Signature I 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 /> MECHANICA Company <br /> Signature Registered Y/ N Fce Curtent Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: <br /> Fill out application completely. <br /> Owner 8 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 drewings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />