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e��-�so-oozo City of Zephyrhills Fire Fax-813-780-0021 <br /> . <br /> ,. Permit Application <br /> Date Received Phone Contact for Pertnit ��� <br /> Owners Name � S ��'o Ovmers Phone Number ��3 8'� G�jB-� <br /> Owner's Address 3�300 �/ �`�' �v�- ,�,d� �-.�// � , <br /> Fee Simple Titleholder Name TiUeholder Phone Number �� �� C� <br /> Fee Simple Titleholder Address <br /> � xa°;a� : 5.`;,. - iS.� �;yv..,�;_e.=„- ��. �. .. <br /> .�tR . . . . <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> - � ...,n,,, �. ..»_ . ..�. :..:•: -,, ,�,:.... ,� � . . , T. ..r�� w. ��a��: <,: <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent } <br /> � Comm Exhaust Kitchen Hood/Duct Q Hazardous Mate�al (Tier II or RQ Facility) ANNUAL <br /> � ConVolled Bum Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Instailation <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> ❑ �Fr y emi �n er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ �� � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ C� � Sprinkler System Installations <br /> Hood Suppression � ❑ ^5d' ❑ C� � Standpipes (Sprinkler Sys) <br /> � �\ <br /> Fire Alarm Installation � Toroh Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> Contractor , , • Compa�y , . . < � . . . . , <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN <br /> Company <br /> Signature I 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 <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Compa�y Se�z�ri � ��e ��;I�n�.�7 � G� <br /> Signature Registered N Fee Current N <br /> Address <br /> License # (�� ��qlo <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 />