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a��-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> PeRnit Application <br /> Date Received • (�{�'2��2' Phone Contact for Pertnit . `� � q�6 ' 6 6 <br /> l.L __-.- .. . ..�_ .. . . - <br /> Ovmer's Name � C�,1�5 � 2� Owners Phone Number �!�3 ?$'d �0 <br /> Owner's Address �O�3 y �°"�`'�� �`Ja <br /> Fee Simple Titleholder Name TiUeholder Phone Number �� C� �� <br /> Fee Simple Titleholder Address . .. . < . . <br /> ,,�.z., � • ;�� .�,, . �,,.,.,�a..�:,�>����:. ;�:+ °,�a;�.�*����.�;, <br /> . . �Sr�'m�.%;Y,:?. b�-'F^�:"&'.4..i:t6»�.�.."1.°:§;.,°d�wa�'�%��°M'�'f=".�'.e. , : C� <br /> Job Address 5�"w�'�'� Lot# <br /> Sub Division Parcel# <br /> „� r � -�.>�.+,x-.t.:�� � .� . �s,.> ,: <br /> .. • � , r:=�s�,.� ,�r za._..._�.�e:r.�-;-�.s�•�.�..., .. s • . �. . . .. ,.. <br /> � V Bio-Hazard Waste Storage-ANNUAL y � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Mate�al(Tier II or RQ Facility)ANNUAL <br /> aControlled Bum � Hood Installation <br /> QEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> �, Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �G � � <br /> U� <br /> ❑�y emi �n er ❑ � j !/ <br /> Sprinkler � ❑ ❑ Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ Sparklers <br /> Hood Cleaning ❑ ❑ ❑ �� � Sprinkler System Installations <br /> ❑ �"�'� Standpipes S nnkler Sys <br /> Hood Suppression � ❑ � � u � � P � <br /> � Fire Alartn Installation � Torch Roofing(far Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL � Valuation of Project <br /> � Fuel Tanks <br /> Q Other. M ..s .. F. ,. � , . <br /> „ � , . .s.. •. . .:-.. , .r.a. , . �.. ., a „ ` .� �r. ' , 33b.' ...�.J!3f''�;�$; ., Sk✓ <br /> Contractor Company �i '�"'� itG-- <br /> Signature Registered Y/N Current Y/N <br /> Address .D. � �/ 3 License# <br /> ELECTRICIAN Company <br /> Signature � Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Curtent Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address . . . _ ... „ . � . � , License# . ,... , ... m r fi. , ., . . ,. <br /> Directions: <br /> Fill out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contrect 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:!lappraiser.pascogov.com) <br /> }•._ <br />