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a�aaao-oozo City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date R�ebeived Z-1 Z, —( 1 —� Phone Contact for Permit � l 3 qci (� 6 6 <br /> -�._ <br /> Ovmer's Name ..5o n. r� S � j� Q Owners Phone Number g � 3 ?� Z, y 2�2 <br /> Owner's Address �p �p C'� �p (� c�� � �1 J -� ��-� 2 <br /> Fee Simple Titleholder Name Titleholder Pho�e Number ��� �� <br /> Fee Simple Titleholder Address �—.��J <br /> - . .. . •� a.PC � - <br /> JobAddress �O �O �Co CTti.�� , 17� (� � �{�j 33��F2 �Fa �r�.,; � .. <br /> Lot # C] <br /> Sub Division <br /> Parcel # <br /> .. . .� , C9:' `w _, <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent ' � <br /> � Comm F�chaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlied Bum � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Naturel Gas-Installation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ � emi � er ❑ <br /> Sprinkler O ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ �� � Sparklers <br /> Hood Cleaning � p p � � � <br /> � Sprinkler System Installations <br /> Hood Suppression ❑ ❑ � C� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL <br /> � �-� Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contractor � . <br /> Signature Company �'� � f,�,� J ` <br /> / <br /> Registered Y/ N Fee Current Y/ N <br /> Address .O. �OX �g8 (�,,,�,d ps � License# <br /> ELECTRICtAN <br /> Signature I Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> PLUMBER License # � <br /> 5ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> 1AECHANICAL <br /> 3ignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # —� <br /> )THER <br /> iignature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> )irections: <br /> License # � <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 worlc over $5000) <br /> Suppty two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittai date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />