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�i 3�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received r � Phone Contact for Pertnit �—� �� � <br /> Owner's Name /e —�-��� 1��� Owner's Phone Number �'�� �/(d� S'�U3 <br /> Owner's Address .S`� �' �j�-GL �L (�� z� �,�.�� �� . <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � C� <br /> Fee Simple Titleholder Address <br /> ,� „� s• �� � �.<,.., 3�,- :a , _ , <br /> -- ��:z,== ur.€cs��. . , <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> , , ..�3$:y, . r .5 ..�...ii .`> ''t''-.,_ . , ' . �. .� ` tt :.F�.�....._ :. ji .. . , <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � 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 /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> � �y] emi �n er � <br /> Sprinkler ❑ � � Recreational Bum <br /> Fire Aiarm � ❑ ❑ ❑ �� � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ � ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> a Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <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 <br /> Company �C'v �7 ���' Ez�v:i�f,-K-..ry LG e <br /> Signature Registered N Fee Current N <br /> Address <br /> License # �.�DGt��//�9G <br /> Directions: � <br /> Fill out application completely <br /> Owner & Contrector 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 />