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a�3aso-oo2a City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> ate Received T�� Phone Contact for Permit f�� n, � r�� <br /> ��J � <br /> �vner's Name �� � "��� (� � (� <br /> Owner's Phone Number �_�_� I J-��, <br /> wner's Address u �' � �,S � <br /> �e Simple Titleholder Name Titleholder Phone Number � �� C� <br /> �e Simple Titleholder Address <br /> �b Address � � � 1 � U ' 2'� �1'�l �� �, ��j Zi Lot# � <br /> �b Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL a Hazardous Material(Tier II or RQ Facility)ANNUAL.�, <br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation �°"'� <br /> � Controlled Bum � LP/Naturai Gas-Instaliation <br /> � Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Emergency Generator>30 kw Q Places of Assembly-ANNUAL � <br /> � Fire Protection Maintenance-ANNUAL � Recreational Bum <br /> � emi � er <br /> L ,,,.�,`C��Sprinkler � ❑ ❑ p V <br /> ��1ec Jw � Sparklers � � � <br /> Fire Aiartn � ❑ ❑ ❑ �� � Sprinkler System Installations � � i�5� I 3�e' <br /> � � Hood Cleaning � ❑ ❑ ❑ �� � Sta�dpipes(Sprinkler Sys) ���-�'� <br /> , Hood Suppression � ❑ ❑ ❑ � � Torch Roofinglfar Kettle 7-' <br /> �4' � <br /> � Fire Alartn Installation � Waste Tire Storage ANNUAL <br /> �' � � Fire Pumps <br /> Fire Works ! <br /> � Flammable Application-ANNUAL , Valuation of Project <br /> Fuei Tanks <br /> � Other: <br /> �ntractor �,(� Company <br /> gnature V� ��, V� � L � Registered Y/N Fee Current Y/N <br /> Address � LiCense# <br /> _ECTRICIAN � C�/� �.� � Company <br /> gnature `� �' <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> _UMBER <br /> Company <br /> gnature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ECHANICAL Company <br /> gnature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> THER <br /> Company <br /> gnature Registered Y/N Fee Curre�t Y/N <br /> Address <br /> License# <br /> �rections: <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 hvo(2)sets of drawings with applicable documentation <br /> Allow t 0-14 days for review aRer submitta)datg. Par�el#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br /> �� �A�',C' . � �� <br /> ��� � ,� S <br /> � �5 ,,�-x k, ��� ��,v <br /> '� � <br /> ��� y�-�: <br /> �I ,k � <br />