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e� 3-��r -002o City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Pertnit _��� <br /> Owner's Name �O u..r �ir ,T��P� Owner's Phone Number �/,j ?� SG � <br /> Owner's Address s��7 C� ,gL v� z �� �� �c=L - <br /> Fee Simple Titleholder Name �� �� � <br /> TiUeholder Phone Number <br /> Fee Simple Titleholder Address <br /> �,.,.,,. <br /> , .-,�:s.ne,.E��>�- .,. . , <br /> . . �� wa'�.:,�§.„'�' , <br /> Job Address � <br /> Lot # <br /> Sub Division <br /> .�_: . , .� ., , � , . <br /> Parcel # <br /> .. ., ;� :. .. <br /> � s ., . , ..� <..... , . . . �.,a�<4 :�...:��.. ;; ;h , ,. . .. , <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 /> ❑ � emi � er � <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ C� � Sparklers <br /> Hood Cleaning � p � � � ❑ <br /> Sprinkler System Installations <br /> Hood Suppression ❑ �( ❑ C� � Standpipes (Sprinkler Sys) <br /> � Fire Alartn Instalfation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL �� <br /> � Fuel Tanks � Valuation of Project <br /> Q Other: <br /> Contractor , , ' r .. • - , t . F `t ' <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Signature � Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # � <br /> PLUMBER <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # � <br /> MECHANICA <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # � <br /> OTHER <br /> Signature Company � .- �-� � �' � G � <br /> Registered / N Fee Current N <br /> Address <br /> Directions: . - . License # �Z / � <br /> Fill out application compietely. � <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 h //a <br /> ( ttP: PPraiser.pascogov.com) <br />