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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Rbceived • —�,� Phone Contact for Pertnit <br /> . _ ., �-�,��._�-,�.,:�;�.:,�,_� _ �����.�� .w. :..,� �.���-��:..5. ,.,��.._. <br /> Owner's Name P( (/� , ` S Owner's Phone Number � U �� <br /> Owner's Address � <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � � <br /> Fee Simple Titleholder Address <br /> ,. . � . . -�.;�r�s�-;. x,�' _ .,�^ -.�as <br /> - .�:,.,.....�F'� <br /> Job Address Lot# C� <br /> Sub Division Paroel# <br /> p- � ' e-.W# *"'"wa": -„'S+'sit.t<..5"°d#'fi��4:;.���. _ :b=Wz'aleFrS_i3_"'r°T�.'sr4w>.%a,� < .;d.a+e.^-:.� „-r•-dw`. � � , <br /> � . '.' . a�s:'":° 'S.�r.,m�.#Y'.�si'RA...S!_.t l."+w. ��f_ ....4°�`3`.P'n.�,ap9'.w±1„s+.}Ai77sT.':"i <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> aEmergency Generator<30 kw � LP/Natural Gas-Installation <br /> a Emergency Generator>30 kw � LPJNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑� emi �n er � <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ �� � Sprinkler System Installations <br /> Hood Suppression � ❑ C�/ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> � Fire Works <br /> a Flammable Application-ANNUAL � Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br />�_ . r .�,��.��-,._,;,.. , <br /> _ �,.s.� ��.a�r,�.. _ .�tl3F! . :f' .�, _ , , -.4..,s��t�°. "d�. <br /> Contractor � �'� � Company — � <br /> Signature � �Q ��C��cLLJ - Registered Y N• Fee Current Y/N <br /> Address �, r►�.p�� /��� ,n/TjU�,/ C License# <br /> ELECTRICIAN 3S/ Company <br /> Signature Registered Y/N Fee CuRent Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Company <br /> 5ignature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> JTHER <br /> Company <br />>ignature Registered Y/N Fee Cur►ent Y/N <br /> Address <br /> License# <br />)irections: <br /> Fill out application completeiy <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:llappraiser.pascogov.com) <br />