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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received , Phone Contact for Pertnit �a- 55j0 � <br /> Owner's Name � �1 r' 6��on5 �C- Owner's Phone Number b �3 � � <br /> [1 M- -+ i� <br /> Owner's Address � a-1 '1�`�.�L-�� � �4 M � <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � �� <br /> Fee Simple Titleholder Address <br /> Job Address I�s0 ��LC-- �`-�'� � N 2 /s L.,s ��^ Lot# � <br /> Sub Division Parcel# ° '�� "U� ' ������ <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 � LPlNatural Gas-ANNUAL Sale <br /> n Fire Protection Maintenance-ANNUAI � Places of Assembly-ANNUAL <br /> ��'' �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ ❑ d � � Sparklers � f?j��� <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> aFire Alarm Installation a 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 /> Q Other <br /> Contractor Company D�p � <br /> Signature Registered Y/N Fee Current Y/N <br /> Address LiCense# �f ciZ b <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 owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply rivo(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 />