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a�a-�ac-co2o Ciry of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br />)ate Received Phone Contact for Pertnit <br /> psta'�eae%'zm,e+ry-4�,x- . . 'YCHM"'k+4%i�i.iYtr 5..•./.#�F' ..W^�=�+H�.+e� _, . °'�FYY bEmTa.,ua <br />�wner's Name � -C u Wl//�. Owner's Phone Number ��3 �� T r � <br />�wner's Address �435' �►l � �V �� � �� �` �� " <br /> Fee Simple Titleholder Name Titleholder Phone Number � C� �� <br /> Fee Simple Titleholder Address <br /> - :.a�� � <br />�:r, �, _.. , . ; -� ;,z..:�.�a- - -�.„:. � � <br /> Lot# <br /> Job Address <br /> Sub Division Parcel# <br />,.. ., *._ _;>.��&"r- ..�m�«.�-�w.�.s�k�-::�na:�i�..t�°w� . �� ---�=r�:�:.»�; «,A;s.�.n=.�y..,.a .�.,�r.x:�* <, „- -...-, �..��°`n:.°5-.:+°��;���':w:°k�.i..�.:+�^*a�a,�.w��.,y�:c�w.�±� ,..:;�•,�^`s�f��-` <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> aControlled Bum � 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 � <br /> � emi � er � / ��/ <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum I <br /> Fire Alarm �❑ ❑ �L � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Insta�lations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> aFire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> aFire Works <br /> � Flammable Application-ANNUAL , Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> Qi ''��i: R�9,'-' i. °%�Gr`'.�S�:dC'e��.. ._ " � '��;��.�:J'w::;.sm_s.�'��.'�L'I�fi^-�z . :�CT� _ - ' " _ ' _ �+�+,_3 i <br /> Contractor � Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/(�I Fee CuRent 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/N Fee Current Y/N <br /> s <br /> Address 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 />