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813-780-0020 City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received �' 7.f l� Phone Contact for Permit 9 <br /> - . �S� �5Q d <br /> Owner's Name lI L�f'i L ��I�S �A�(� iCLt /QV ���.�.. pWner's Phone Number [� �� � <br /> -^T L��J <br /> Owner's Address � ��� �jQL(aLL /�� �Ld� L � � � F 33s-�/Z <br /> Fee Simple Titleholder Name �� � �� <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address � <br /> Lot # <br /> Sub Division <br /> Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlled Burn � 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 /> tr y emi � t er '�� �� <br /> Sprinkler � ❑ ❑ � Recreational Burn � <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 <br /> � Valuation of Project <br /> Fuel Tanks <br /> � Other� <br /> Contractor <br /> Signature s Company ��+r �� Xinnr <br /> Registered Y/ Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Signature <br /> I Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> OTHER <br /> Signature <br /> Company <br /> Registered Y! N Fee Current Y/ N <br /> Address <br /> License # <br /> Directions <br /> Fill out application completely <br /> Owner & Contractor sign back of apphcation, notanzed (Or copy of signed contract wrth owner) <br /> If over $2500, a Notice of Commencement is reqwred (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 htt //a <br /> ( p. ppraiser pascogov com) <br />