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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> . , Permit Application <br /> DateReceived� + ,Z� � - - ---- - _- -- .. .:_ PhoneContactforPermit � �-�� <br /> _,... - --- - ..._--- --- . . ... . _. .. . _ _ . .._ <br /> Owners Name �/� � (� G� � � Owriers Phone Number � � � <br /> Owners Address �3�75'� �/¢/�j � � H� /t �� �+ ✓?��7 r�'• <br /> Fee Simple TiUehofder Name YiUehotder Phnne Number � �� � <br /> Fee Simpie TiBeholder Address <br /> - �-- - - -. � .._.._ :.. ---..... ------------......... -- --- - . .. -- <br /> --- -__.._�_.-.,.:._._---:-__:-_ - ----° ----- � -- <br /> ..-._.. - .-. -_-. -..-- - -._ :_._. ..-_-._-: -� - <br /> =------ -� <br /> Job Address �-�# <br /> Sub Division Patcei# <br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigation Teni <br /> � Comm Exhaust Kitchen HoodJDuct � Hazardous Materia!(Tier 11 or RQ Faality)ANNUAL � <br /> � ConUolled Bum � Hood Instaila6on �r' <br /> aEmergency Generato<<3U kw � IPRJatural Gas-InstaUaUon J�j 2��y,�'V <br /> Q Emergency Generator>30 kw � l.P/Natural Gas•ANNUAL Sate � �� U�/,� <br /> � Fire Protectfon Maintanance-ANNUAl. a Places of AssembtyANMUAL 2�'�� � � ,,,�JC/t"� <br /> � em � er � � J ���r� <br /> Sprinkier � ❑ ❑ t� � � Recreationat Burn ��._ __ <br /> Fire Alarm � � O � � � Sparfclers �' <br /> Hood Cteaning � � ❑ O � � Sprinkler System InstallaUons ��3 � �� N� <br /> Hood Suppression � ❑ � ❑ � � Standpipes(Sprinkler Sys) '�P <br /> Q Fira Alarm InstalleGon a Torch Roofing/Tar Ketlie i� � <br /> � Fire Pumps � Waste Trre Storage ANNUAL <br /> � Fire Wo�1cs <br /> � FlemmBbleAppliCation-AIVNUAI. �—�� Valuation of Projec# <br /> � Fuel Tanks <br /> [] Other: <br /> Contractor Company .3+�• f,t L' . <br /> signature ,.�� Registered Y/N Fee Current Y/N <br /> Address License!� <br /> ELECTI21ClA1V Company <br /> Signature ( ftegistered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Reg3stered Y/N Fee Curcent Y/N <br /> Address License# <br /> MECHAMiCAL Campany <br /> Signature Ftegistered Y/N Fee Currenl Y 1 N <br /> Address License# <br /> 07HER Comparty <br /> Signature Registered Y!N Fee Cuaent Y/N <br /> Address License# <br /> _ --.._. ._...._. .... .---._ .. .. ...,.- -- - __ _ - - - - _. <br /> DirecUons: <br /> Fi11 oul appficalion completely. <br /> Owrser&Contraclor stgn back of application,nofarized(Or,copy of s+gned cont�ect�vith owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical v�rork over$5000) <br /> Supply iwo(2)sets af drawings with applicable documenlation <br /> Allow 1Q-14 days for review after submittaE date. Parcel#-obtained irom Property Tax NoUce(http://appraiser.pasoogov.00m) <br />