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813-780-0p20 Ciry of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Pertnit ��.� <br /> Owner's Name I < <�� �- o �/' i Owner's Phone Number ��3 �� <br /> Owner'sAddress �,J� � `l L �� i ��S yZ <br /> Fee Simple Titleholder Name TiUeholder Phone Number �� � <br /> Fee Simple Titlehoider Address <br /> . ,R., „ n-: :�.�rrix. �°��:��;�.. ,»,. »a • .. � �:-^'-�a�•�w� .s�?s��uC4da,>".e�» --:s>.�. . •- , <br /> Job Address 3 �-� � � � . S ' � �l � 2 Lot # � <br /> Sub Division Paroel # <br /> - .. .. .... . .D^h�. - ,. �v,•^ .....,.:te.�. .;i�..,_..., -�5:�. � , , .. .,. -�t�. ..+�F.-'-,r�iro.iw..+rz>.a:.. ,;.;a�s:.. �. .._t...� ° . n .. . <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 Q LP/Natural Gas-Installation <br /> � Emergency Generator> 30 kw a LP/Naturel Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � RecreaGonal Bum <br /> Fire Alartn � ❑ � � � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> a Fire Works <br /> a Flammable Application- ANNUAL , Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> . . , . . ., .. ..... . . � � . ,. .. .. . , : M.. �.� . . : <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 � 'Z /' � i � �<I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> MECHANICA Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> Directions: , , . , ... . . .. . , : <br /> Fili 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 tk - obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />