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813-780-0020 <br /> City of Zephyrhills Fire Fax-813-780-0021 <br /> . Perrrit Application <br /> Phone Contact for Pertnit _ �_ <br /> de Received -m �'�'�°"�""°""��`� �171 �� <br /> -, a _ - 'U14_`SR�Mi>'4•Yr'�c-S'?o:�.�...i' -a .t 4.� ,,. � L— 1 ..��� <br /> � � n�y�� Owner's Phone Number _� <br /> vner's Name C <br /> Nner's Address r"—"—"� �� I I <br /> Titleholder Phone Number � �---� <br /> L-- <br /> ae Simple Titleholder Name <br /> se Simple Titleholder Address _ :=� �'� ��``°'�" <br /> <�wr...,,���:� ��� �� <br />�b Address <br /> �3 G �,�� �3 ► v�. �� .� I-�� � �.s l�r� 3�G1�-- �ot# <br /> Parcel# <br /> ub Division `�' � � <br /> n�ws9r^^��a. ..ra4P�k_ ' - <br />� r .•aw; -F,:,ia.c�'. . � ' - - � � � <br /> � Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Fac�lity)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Naturel Gas-Installation <br /> � � LP/Natural Gas-ANNUAL Sale <br /> Emergency Generator>30 kw � <br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> � emi �n er <br /> Sprinkler ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ C� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ C� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storege ANNUAL <br /> � Fire Works �� <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> � Other: , <br />&_.,�, . . :,�'9�'++R'FYE�7:�,.� _ ,.. �. �_ <br /> _. +'!A':�C°'g'#rM'ac�su°=k, ,, <br /> Company C— /�� e�r� l <br /> Contractor <br /> Signature �- � U/'� Registered Y/N Fee Current Y/ <br /> License# <br /> Address <br /> ELECTRICIAN Company <br /> Registered Y/N Fee Current Y/N <br /> Signature <br /> License# <br /> Address <br /> PLUMBER Company <br /> Registered Y/N Fee Current Y/N <br /> Signature <br /> Address <br /> License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Curtent Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directio�s: <br /> Fill out application completely <br /> Owner&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 />