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aisaao-oo2o City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received � Phone Contact for Permit },q'} 9L.+Z ( q(�3 <br /> Owner's Name P/ — ��, p/ Gi.� Owner's Phone Number � 7� CC <br /> Owner's Address b p �( l � / � �. / � � � <br /> �'/ <br /> Fee Simple Titleholder Name �� � �� <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address � �� <br /> Lot # <br /> Sub Diwsion <br /> Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Nazardous Material (Tier II or RQ ANNUAL <br /> � Comm Exhaust KitChen Hood/DuCt � Hood Installation <br /> � Controlled Burn a LP/Naturai Gas-Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Eme gency Generator > 30 kw � Places of Assembly-ANNUAL <br /> � Fire Protection Main!erance - AkNUAL � Recreational Burn <br /> � � 1' �. � ef � <br /> Sprinkter Sparklers <br /> Fire F,larm � O ❑ ❑� � Sprinkler System Installations <br /> Hood Cleaning � p ❑ ❑ C] � Standpipes (Sprinkler Sys) <br /> Hood Suppression � ❑ ❑ ❑�� � Torch Roofing/Tar Kettle <br /> � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Rre Pumps <br /> � Fire Works <br /> � Flammable Application- ANNUAL "�� <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other• <br /> ContraCtor �. . � - ._ _.._ . - __,_ �,. _. _ _._. _ _ . .— - - <br /> Company -�—� <br /> Sgnature � <br /> Registered Y/ N Fee Current Y/ N <br /> �adress 353{ {h �or� q'18538000�Apo,Z, � <br /> License # <br /> ELECTRfCIAN <br /> Signature <br /> Campany <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/ PJ J Fee Current y/� <br /> Address � <br /> license # <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address � <br /> License # <br /> vTHER <br /> Company <br /> Sigra:ure � <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> _ , <br /> License # <br /> _._.:_. <br /> Directions: - : , - _ _ _ _ ,. <br /> Fill out application Completely <br /> Owner & Contractor sign back of application, notarized (Or, copy of s�9ned 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 applicabte documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov com) <br />