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\` -� �-� �� �i <br /> sisaao-oozo City of Zephyrhills Fire v ` Fax-813-780-0021 <br /> Permit Application <br /> Dat4 Recei�-e� Phone Contact for Permit r /�� � 0O <br /> '" L.��J <br /> Owner's Name �� s Owners Phone Number �� s �1 S w <br /> Owners Address Q(� .� �.�,! G� �1 {, � r�µ / r�� t—{ �� 3�' g Q � <br /> Fee Simple Titleholder Name Titleholder Phone Number C� �� <br /> Fee Simple Titleholder Address <br /> � �: , <br /> Job Address �� oa G� t� �`J � �-� �'1 � h 11 � S �` 3 3 S'CZ Lot # � <br /> Sub Diwsion Parcel # 3�1 �� ���0 �� lOd �� <br /> � Bio-Hazard Waste Storage - ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a 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 a LP/Natural Gas-ANNUAL Sale <br /> � 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 /> Contractor <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICA� Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> Directions. <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 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 /> �t-�, : ,�.,�i d � � �P -�- <br /> 5 335 B � �`�z-�-�t <br /> 2�e �� r h��� t s,�L <br /> 33S`f Z <br />