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� 813-780-0020 City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> DateReceived �(B l/ Pnone_Contactfor�ermit },q�. qt-�,2 ��}�3 <br /> Owner's Name £i(�/� �j 1 C, � /�rZT��,a � <br /> Owner's Phone Number �� ��� � b� <br /> Owner's Address EY / ��. � /� /� r � � ��/(�� �L � 3S�y i <br /> I <br /> Fee Simple Titleholder Name � �� � <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> JobAddress f�7/� /,�,g,�y � �/7 !'Z Y�J�,{/'--c -_ - -_ <br /> � Lot # C] <br /> Sub Divisio� <br /> Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier II or RQ ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation <br /> a Controlled Burn a LP/Natural Gas-Installation <br /> � Emergency Generator < 3o kw � LP/Natural Gas-ANNUAL Sale <br /> � Emergency Generator> 30 kw � Places ofAssembly-ANNUAL <br /> � Fire Prc,ectic�� A�iair�tenar�cz - ANNUAL � <br /> Recreational Burn <br /> t y emi � er <br /> Sprinkler � ❑ p �' � � Sparklers ��, !� <br /> Fire Alarm � p ❑ ❑� � Sprinkler System Installations �� <br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) <br /> Hood Suppression � ❑ ❑ ❑�� � Torch RoofinglTar Kettle <br /> � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works <br /> � Flammable Application- ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other <br /> _. „ .. <br /> -: __. _.�:-., -_:. .-._: - ,:. - :•...:_:_.::;z <br /> Contractor " --- � - . , <br /> S�gnature <br /> Company -T-- � <br /> Registered Y/ N Fee Current Y/ N <br /> Aadress 3531 � �or► Q$ g 1 � <br /> License # Z <br /> ELECTRICtAN <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address � <br /> License # <br /> PLUMBER � <br /> Signature Company <br /> Regisi�red Y/"d Fee Current �' / y <br /> Address <br /> License # <br /> MECNANICAL <br /> Signature Company �—' <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # � <br /> vTHER <br /> Sigr,ature Company � <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> ;,_,., License # � <br /> DirecUons: - - - , ,, --- _ <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with o�Nner) <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 #- obtained from Property Tax Notice (http://appraiser.pascogov com) <br />