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ai 3-�ao-oo2o Ciry of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br />>ate Receiv�d Phone Contact for Permit <br /> t.- . �. -:a� ..-e«�•{v-'i! � _ . -�Affi.Jrm+d:�y,A�'�f4p�+tl'i+i%i'FS���uwa;pti.tR�Poam..ss-.FWa«cL..a�;�r���-.- ; .r�plr:f.p�btis+l9sS'F&Y-`T++6�*'4"as �. W sl�- � <br /> hroners Name i e u,;�r I�/E. L L� Owner's Phone Number � �f�j z � <br /> hNne�'s Address � �!' � K�. f ( l� <br />�ee Simple Titleholder Name Titleholder Phone Number � � � <br />�ee Simple Titleholder Address <br />+� . 7. ° .�:._,��;�� ��s_ . :.��-. °a�' <br /> iob Address �� Lot# � <br /> iub Division Parcel# <br /> a .� �^�:x,, ;,oe-«�zti;c:�,--,°^.�_,,, , . _ -. .- � � - - � ,_ � <br /> �:�-=_ -ae� <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> Q Comm Exhaust Kitchen Hood/Duct � 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 � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintena�ce-ANNUAL � Places of Assembly-ANNUAL <br /> �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 /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <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 /> x ,., „ . �,,,��:�,..�...,��,� � _ _:� :-�� «��:. �, . ,� °' � <br /> Contractor Company <br /> Signature � Registered Y/N Fee Current Y/N <br /> Address � ,s �r �2(,L L 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 /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directions: <br /> Fill out application completely <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with ovmer) <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 />