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813-780-0020 City of Zephyrhills Fir�e <br /> Permit Application Fax <br /> Date Received �---� - <br /> . Phone Contact for Pertnit 7 2 7 _ 2 I S C.l� p � <br /> Owner's Name z,�PH �H«�S t�k o(di � z'j Owner's Phone Number $ i 3 7$'L �(, O� <br /> Owner's Address �s $ S/ (fu�, Rk �o,o� z,Gp� � y�uS J�G 3 3 S 3 �1 <br /> Fee Simple Titleholder Name � �� �� <br /> Titfehoider Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address �o � s/ ��a �2.� l�e p� �=�►�.�q N�� LS fG. 3 3� 3 '� <br /> � Lot # � <br /> Sub Division <br /> .. . ....... .. .._...,...__,_, _ Paroel � <br /> :. . _ . ;,. . __. _._.. _._ -.-„- <br /> -- <br /> � BiaHazard Waste Storege - ANNUAL a � <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> � Controlted Bum Hood Installation <br /> � Emergency Generator < 30 �, � LP/Natural Gas-Instalfation <br /> � Emergency Generetor > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance -ANNUAL Q <br /> Places of Assembly-ANNUAL <br /> [QCrTy emi � er <br /> Sprinkler <br /> � � G' � � Recreational Bum <br /> Fire Alartn p ❑ ❑ � � Sparklers <br /> Hood Cleaning � � � � <br /> Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ C� � Standpipes (Sprinkler Sys) <br /> � Fire Aiartn Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammabie Application- ANNUAL <br /> Z SO, o�, Valuation of Project <br /> Fuef Tanks <br /> Q Other: <br /> __�..__�_.,�.___�_.�:�._... _ _. ._ _ _ <br /> - ... _.._. __ - - - <br /> _ _ - — � _..__.-. <br /> -- - - - -. <br /> ontractor - _ _ -- -- --- .�,_. ._ .- -- <br /> Signature ��"`+ • �- CompanY (,eJ S� t �+i ;tc r�a.. ,� � v�G ' LLG <br /> Registered Y/ N Fee Current Y/ N <br /> Address Z.�E, i�o , � �. vA �;.NST n-a � rG �3 3 770 License # <br /> st3r67 avu,zoc�, <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/ N Fee Currerrt 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 /> -..„<,-._.�...., -_..w License # <br /> _<.._..�.._._ . _.._.__M.._ , <br /> Directions: - -°-- _ _ - - - --- -• - _ - �. _. ..- - - <br /> ` _. _._ _ M.a..-..,-,_-�-_.. <br /> ill out application completely <br /> -- -- - ---..�. .__. .,,,_._- ___..__ _ _ <br /> Owner 8 Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice o# Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with apPlicabla documentation <br /> Allow � 0-14 days for review after submittal date_ Parcel #- obtained from Pro <br /> perty Tax Notice (http://appraiser.pascogov.com) <br />