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s�3aso-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received , " Phone Contact for Permit }��3 a(o s g�— <br /> Owner's Name �'evL i �,,, �J S Erw� �✓,,�6Q� Owner's Phone Number �/3 �� �D� <br /> Owner's Address <br /> Fee Simple Titleholder Name Titlehoider Phone Number � � � <br /> Fee Simple Titleholder Address <br /> JobAddress �.3.�C� ,.. �Q� ZE � �`�t� ��s Lot# � <br /> Sub Division Parcel# �.�—���sZ) ��0 '�(cs�0 O"'��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 Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � <br /> � Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL 1 (C �„'T�L <br /> try em� �n t er � � 1�� O .L{j��F�" - <br /> e(((,,,,,,���S�.�.,�� <br /> Sprinkler � ❑ ❑ ❑ � Recreationai Burn �� � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkier System Installations � �3,j�'� <br /> l <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 /> � Flammable Application-ANNUAL °ti Valuation of Project <br /> � Fuel Tanks <br /> 0 Other: <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 Fee Current Y/N <br /> Address S�� ,. " 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 /> Suppiy two(2)sets of drawings with appiicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />