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s�saso-oozo Ciry of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received �� Phone Contact for Permit �� !� ��[/,�3� L .��J Owner's Name � ��N � �' � � � �+�.�r �� � r � L�S1J L UUI Owner's Address Fee Simple Titleholder Nama. Titleholder Phone Number � C� Fee Simple Titleholder Address .... a - ;9 . .. Job Address Lot # �� Sub Division Parcel # � Bio-Niazard Waste Storage - ANNUAL � Fumigation Tent � Corcim Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Bum � Hood Installation � Emergency Generator < 30 kw � LP/Natural Gas-Instaliation � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL ❑ try emi �n t er ❑ � � // /� Sprinkler ❑ ❑ ❑ Recreational Bum �� tJ Fire Alarm � O ❑ ❑ � � Sparklers Hood Cleaning � ❑ ❑ ❑ � Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ �� Standpipes (Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire �Norks � FlammableApplication-ANNUAL Valuation of Project � Fuei Tanks Q Other: Contractor ,, , - Company Signature �` Registered Y/ N Fee Current Y/ N Address License # ELECTRICIAN Company Signature Registered Y/ N Fee Current Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Current Y/ N Address �— License # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address License # OTHER Company Signature Registered Y/ N Fee Current Y/ N Address License # Directions: Fill out application completely Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drewings with applicable documentation Allow 10-14 days for review after submittai date. Parcel #- obtained from Property Ta�c Notice (http:l/appraiser.pascogov.com)