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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application � <br /> >ate Received i- "3 v — Zv`' Phone Contact for Permit (� �'7 2.[>��, <br /> . ._ ,. ..- .... ,�»�s���,.�,..,�.�..,�.,�,. >... �...•�., �a... < ,_ rt.��.�. «Mr,�.�. . <br /> Nvner's Name �—��p�. � Owner's Phone Number �j� ��b� �.Q� �9 <br /> h�vner's Address ��,�'� �"7 A-1�C" �L(/'� 2"_�[ (.,L� .�. � "3'�SCk 1 <br /> V <br /> 'ee Simple Titleholder Name Titleholder Phone Number �� � � <br /> �ee Simple Titleholder Address <br /> ,, ._ ,;,�,. ^�ss 3�:a��.�.: <br /> r��� 7l z <br /> iob Address Lot# � <br /> >ub Division Parcel# <br /> � „ ,.�e;,;-..,..�, , _ ��:•�. ..-,��„��-,�,,� � <br /> � - �:��;�N;�;=� <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale �/,�/ �c�') <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �' ����v <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ O B � Recreational Bum <br /> Fire Alarm � O ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations �•r ,.+�lp��� D� <br /> Hood Suppression � ❑ ❑ ❑ �� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> � Other: <br />,__�., . LL�,� -,�:��-�;_ ��:.a�- .: .�:���..�,-.<}��- � . �. <br /> Contractor Company -�.�" I�(1 � " 2 t n�€LL (..� <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PWMBER Company <br /> 5ignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> UECHANICAL Company <br /> 3ignature Registered Y/N Fee Current Y/N <br /> Address License# <br />�THER <br /> Company <br /> iignature Registered Y/N Fee Current Y/N <br /> Address License# <br />�irections: ""'�""'^�' <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:/lappraiser.pascogov.com) <br />