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813-780-002D City of.Zephyrhills Fire Fax-813780-0021 <br /> �Permit Appfication <br /> Date Received ^�R Q r, Phone Contact for Pertnit Q' � � .s'Tf —�'�� <br /> 'r.ii�"m��.�"�k;.�i."�..+.a:.:w...r�...�zw,�..�,..�,K u <br /> Owner's Name � S [�� �j� Owner's Phone Number . 8 �3 �'�S 935� <br /> /� �� �� �� <br /> Owner'sAddress ��. �J q7 ,/v/� � 3367� <br /> Fee Simple Titleholder Name TiUeholder Phone Number C� � � <br /> Fee Simple�TitleholderAddress <br /> a �� <br /> Job Address GOLD�IV p ND,q �7g�s ���-/� ,�L Q Lot# <br /> Sub Division Parcel# <br /> Rfi. <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier il or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Instaliation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL 5ale <br /> � Fire Protection Maintenance-ANNUAL � Pfaces of Assembly-ANNUAL <br /> � emi � er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � <br /> Fire Alartn � C! ❑ ❑ � a Sparklers 7 �� <br /> Hood Cleanin ✓ ��� �� <br /> 9 � � ❑ ❑ � � Sprinkler 5ystem Installations r � <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � '� <br /> � Fire Alartn Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works �•,,,� <br /> � Flammable Appiication-ANNUAL Valuation of F�roject <br /> � Fuei Tanks <br /> Q Other: <br /> Contractor � Company S <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN Company <br /> 5ignature � Registered Y/N Fee Current Y/(� <br /> Address <br /> License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Curtent 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 /> Address License# <br /> Directions: <br /> Fiil out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$250�,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply iwo(2)sets of drawings with applicabie documentation <br /> Allow'10.'14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:/lappreiser.pascogov.com) <br />