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s�s-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 • . Permit Application Date Received 1�� // Phone Contact for Permit �J �Q 0 73� Owner's Name /•'J'a �,s /L a�/C C- (C � ts�,1/L Owner's Phone Number �� � j' ' �J Owner'sAddress d�s� ��Q /4U� �� c �j �� 33s�Z Fee Simple Titleholder Name Titleholder Phone Number C� �� Fee Simple Titleholder Address Job Address Lot # � Sub Division Parcel # � Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent � Comm F�chaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL � Controlled Burn � Hood Installation � � Emergency Generator < 30 kw � LP/Natural Gas-Installation n�" / � Emergency Generator > 30 kw � LPINatural Gas-ANNUAL Sale (�� � Fire Protection Maintenance - ANNUAL Places of Assembly-ANNUAL � emi �n t er � Sprinkler � � � B � Recreational Burn Fire Alarm � ❑ ❑ ❑ � � Sparklers Hood Cleaning � ❑ ❑ ❑�� Sprinkler System Installations Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application- ANNUAL Valuation of Project Fuel Tanks 0 Other� Contractor Signature Company : � �� Registered Y/ Fee Current Y/ N Address License # ELECTRICIAN Company Signature Registered Y/ N Fee Current Y/ N Address License # PLUMBER Company Signature Registered Y/ N Fee Current Y/ N Address License # MECHANICAL Company Signature Registered Y/ N Fee Current Y/ N Address �- License # OTHER Company Signature Registered Y/ N Fee Current Y/ N Address License # Directions: Fill out application completely Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov com)