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a�3-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> ►ate Received � ' Phone Contact for Permit <br /> ,�.T�... ..., � -._.���F;= �,�,»,���.�:����:�-,��.� � ��. — / <br /> �-��.�.. .. .,.>x,�. ��,-.. <br /> hvner's Name ' (�;G, -�' �� � � <br /> -�„� Owners Phone Number <br /> hvner's Address y� ��. , <br /> �ee Simple Titleholder Name Titlehoider Phone Number ��� 7�a �-3 <br /> �ee Simple Titleholder Address <br /> r�.. r . °-��. _. <br /> iob Address �� <br /> Lot# <br /> iub Division <br /> �5»*..,^s-� ..���� <br /> Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Instaliation <br /> � Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL '�(� Places of Assembly-ANNUAL <br /> y�_�� <br /> ❑ y emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � O ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> „�.-<��<-�: � <br />:ontractor <br /> Company <br />>ignature ,�t� Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />:LECTRICIAN <br />�ignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />'WMBER <br /> ignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> IECHANICAL <br /> ignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> THER <br /> gnature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> . License# <br /> rections: ,,,�,^„�� <br /> Fill out application completely <br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signed 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 applicable documentation <br /> Allow 10-14 days for review after submittal date Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />