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s�:�-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> - � Permit Application <br /> Date Received � — Phone Contact for P <br /> �,.�, �, , �.._ , .�:.«>,_ ,._��,. �. _. a .,... .�F,� ertnit <br /> �.,;�. ,�.. . .. - <br /> Owner's Name C/�l (/� ��t� C /� p�er's Phone Number �� �� �� <br /> Owner's Address Q E� �4 U " <br /> Fee Simple Titleholder Name Titleholder Phone Number �� C� �� <br /> Fee Simple Titleholder Address <br /> �, . . � �:�.;.a�_�.��-.��;��s�;�m�,+a�� - ,���;�-�,���.�<__ �a;r� ,s�s�,.-,:,,�,.���> <br /> Job Address � <br /> Lot# <br /> Sub Division Parcel# <br /> p . . s...�-. � . £ . 9•�.kiv_i'�41i4�"A§yM[M'i�.�.,W_mx:t��as.wa,Y�v«:yq.ffi?'#i�`- ���wro�.wx.T-`b?�l,P^ _. a= a ✓- fi A A5 - kY <br /> .,rt �. �uv.. .a. ,. _ vY.i�'i, "sw,'ri:.-,-. .,�+;:: .^..Nt-'Te.+ia'h.':.'k'�"Yr'u.�.. R°._.n a „,p-..., y. .�p�,r�A..�«5'i`Y;HTa*"✓-�._ <br /> � Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood I�stallation <br /> � Emergency Generator<30 kw � LP/Naturai Gas-Installation <br /> � Emergency Generator>30 kw � LP/Naturai Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembiy-ANNUAL <br /> � emi � er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum �j <br /> o ❑ ��I ' <br /> Fire Alarm � ❑ ❑ ❑ Sparklers �� <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> � Hood Suppression � ❑ ❑ � � � Standpipes(Sprinkler Sys) r� /U <br /> I <br /> Fire Alarm Installation � Torch Roofing/Tar Kettle 1 <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> E. �4� _. ��!a �u;tn��'�.�;�^ f�3.�" . _ _ _ . ..��i�- ,. .. <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 CuRent Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> 4, 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 /> 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 />