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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> . <br /> .� ' Permit Application <br /> � <br />>ate Received Phone Contact for Permit <br /> F „ _ ., - . . � .., .�.-.:�,:.,__�°'.�,.m,+a K.�...R:.a�-,w aw�...�,�x.��. s.> .r,. ���,�o��. ,..,�.��-.a�.�� .. .. . � . <br /> hnmer's Name 7 Owners Phone Number � � � <br /> Tn�ner's Address Q / L„ <br />�ee Simple Titleholder Name Titleholder Phone Number � � � <br />�ee Simple Titleholder Address <br />� , . v,se,a�:t;,,.•�:.•t,�. - `z�i:.'�r"d"., . ...� � <br />�ob Address (pp Lot# � <br /> iub Division Paroel# <br /> e: � aR-- �t'.�.sT<:,��,k� - - - . , �F7*^!�+��e.. -�-- �- - - . +w�r��mx��.eM.-.�r-i.-�- , . .� �7M��; ..., . _ <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation . ,/ � <br /> /! <br /> � Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sal � /� /`� "j <br /> n J `� <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNU � <br /> 7`—' �y emi �n er / <br /> Sprinkler � ❑ ❑ � � � Recreational Bum �. <br /> Fire Alarm � ❑ ❑ � � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> aFire Alarm Installation � Torch Roofing/Tar Kettie <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> a Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> s, t ` _ _ ';d9� °tV„ti°..�,} _ _ _ .. $�. _ . ._ ,. 'RJ3` <br /> Contractor Company /�j/� C'�p <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 /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company <br /> 5ignature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directions: � <br /> Fill out application completely <br /> Owner&Co�tractor 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:lJappraiser.pascogov.com) <br />