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si3aao-ao2o City of Zephyrhills Fire Fax-813-780-0021 <br /> � Permit Application <br /> )ate Received Phone Contact for Pertnit <br /> . _, v �.��.��s..��.:s,.x„ . .. _s. ..� .. - ��„ ,�a»..�.�.�,�„ , . <br /> Jwner's Name L;s Owner's Phone Number � � � <br />�hrvner's Address ({/ � <br /> �ee Simple Titleholder Name Titleholder Phone Number � � � <br /> �ee Simple Titleholder Address <br /> :< . � .,�r�,,:.^;�� *� . . . :eKK.-. <br /> iob Address Lot# � <br /> iub Division Parcel# <br /> .� 'K,R" ,''�'.'.�A^C�.�Y$AA� _ . _ , .. . _ FQMiO"�°.L'-.k:_�YAI'�R�Y>5� �" _ ' �%O . <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 a LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL r � <br /> �y emi �n er ,� � 3 j '� <br /> Sprinkler � ❑ ❑ � Recreational Bum <br /> Fire Alarm � ❑ � � Sparklers <br /> Hood Cleaning � ❑ O ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar 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 /> M,n,�> ..�:�.�. �:� <br /> Contractor � / Company , <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 /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br />> <br /> Directions: <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.!/appraiser.pascogov.com) <br /> � ����.� <br /> �1�t.�� ✓ � �l�"� <br />