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a�3-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> )ate Received fl ;Z Phone Contact for Pertnit �/� �""q� � 6 <br /> �.�e.�.��.�N�,:.�.:.,.N,.� _ . ._ ��._. �� �}.:.-�.m���,,�<.�,�..,...,_ <br /> T�vner's Name �� p � ��� � ��L <br /> ~ Yl- Owner's Phone Number �� Jgj� pp c/� <br /> hvner'sAddress � �j c�� r 2d <br /> ee Simple Titleholder Name Titleholder Phone Number C� � �� <br /> �ee Simple Titleholder Address —�� <br /> R_ � „�,,,p z,�: . ,� ��. , . ,,�,�.. <br /> �4�.,... ��,._ <br /> iob Address s� �� <br /> Lot# <br /> iub Division <br /> Parcel# <br /> � m�� _.:6:,�,• .. .. =�.�.a��.��*�,-_<- . <br /> �.-a�:�n��r �, v�c:=. <br /> a 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 a LP/Naturel Gas-ANNUAL Sale � � ��,� <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � <br /> ❑ r y emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <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 /> � FlammableApplication-ANNUAL <br /> aValuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> ._� .._ . ._ -- •a:v,�;���$"�na� .. _ - �Star . .__ ^'S .a: _.=*�r.s-.�c�:�,tla�'�s,r�.^�[ <br />;ontractor — <br /> s8ud€a <br /> tignature �----� �.1��-'." " � Company —r jtiG Y` Ls� �r�� <br /> Registered Y/N Fee Current Y/N <br /> Address C� /„� '� �� �r � � f��G j License# <br /> iLECTRICIAN <br /> ignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> LUMBER <br /> ignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ECHANICAL <br /> ignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> THER <br /> gnature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> rections: <br /> Fill out application completely <br /> Owner 8 Contractor sign back of application,notarized(Or,copy o(signed contract with ovmer) <br /> If over$2500,a Notice ot 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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />