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a�3aso-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received � �� Phone Contact for Permit <br /> -*r+ _ , ,...��..� . _. .., . - � _. ...> �. .. „ _ .. <br /> Owner's Name � Owner's Phone Number �/3 �a � q.�S <br /> Owner's Address ,j v ..�.�i)-LG �� L�� Z , <br /> Fee Simple Titleholder Name Titleholder Phane Number �� � <br /> Fee Simple Titleholder Address <br /> . . �:�.��°;.. t�� qr.: �:,.�», ,,� ����,�:.�=..Yn. -���;:�m�: <br /> Job Address Lot #+ � <br /> Sub Division Paroel # <br /> > .� . . u . ��'�n�:�xa . . -�s?:�'x.. ._ .a�sa��a.r.�va^sr.- <br /> - - - - �e:.:�».>: . s, s: ..;�.-.a- . .. - . �.�:*�rr�:�at=�.�.. <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material (Tier II 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 <br /> a Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � 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 /> F �,._-;«�,..,. -.��� .�f:�, ,.;��-��R�,�,,..�. >�.,����-:�� _ ,��:-�.�����,:� �. . �;x�,�����.F:��;-, <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 <br /> 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 <br /> License # <br /> OTHER Company Pvr�T iC v r,� ,✓? LL� <br /> Signature Registered N Fee CuRent N <br /> Address License # (p,s"�V�^j�j/ G <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 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 />