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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> � ` Permit Application <br /> iate Received Phone Contact for Pertnit <br /> iviFna,�w..�+ay.�:_•. - .... .ts.:�l:"MHCX9.59'-9"�dF#:ks.'tm..p� •;.� . r»iltF,xt.°,�ns'C�.>•..v <br /> �aa <br /> Mmer's Name �V 1/ � � Owner's Phone Number C� C� �� <br /> TNner's Address ��3 I � �L L� � � `-' �_�" �� �z C� <br />=ee Simple Titleholder Name Titleholder Phone Number C� � � <br />=ee Simple Titleholder Address <br /> �,.._..,.ri�,x,..,;.,�.�.. ,�. <br />, :�.:t����.xe,.,,.�ce" � .u�<�s�ss �ea�',- ^ <br /> Lot# �_J <br /> lob Address <br /> Parcel# <br /> 3ub Division -, .�, ,���� � <br /> ��w:,.-:�,�^�-.t�.ar�ss.;.,c�=.�;�::-:;:a,�r,:,-.��c,.,.<�;�w�-. -_,.�-.-«�.. , ..;.,:s.i�:. . ..a�,.s_,r , ;x�-xi....-.�. .e•��-a a .. --��'�'�-n- � <br /> � ,.�,�:�� -'.^°�"�" +'�*'y'°- � <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> a Controlled Bum a Hood Installation <br /> � Emergency Generator<30 kw a LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> �f Jy, Fire Protection Maintenance-ANNUAL Q Places of Assembly-ANNUAL <br /> '-/—_'• � emi �n er ❑ <br /> Sprinkler � ❑ ❑ Recreational Bum <br /> Fire Alartn ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ � �� � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> a Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable App�ication-ANNUAL Valuation of Project <br /> � Fuei Tanks <br /> Q Other: <br />�. .-��. �.�,-- _ ��-����:.:�-.�.��=��Fp: �-���,-��,��•;��-� ;-..�,a:,���-.�.R..���-�.�. .. ���.��_.� r� �.��. <br /> Contractor Company <br /> Signature 1'"����~ Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/I� Fee C:urrent Y/N <br /> Address License# <br /> PLUMBER Compa�y <br /> Signature Registered Y/N Fee C:urrent Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee(:urrent Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee(:urrent Y/N <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:/lappraiser.pascogov.com) <br />