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sisaso-oozo City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received �q -� Phone Contact for Permit [c '�._1 � 1� Owner's Name Owner's Phone Number � � Owner'sAddress � J�� V `J� Fee Simple Titleholder Name Titleholder Phone Number C� � � Fee Simple Titleholder Address i � Job Address Lot# � Sub Division Parcel# � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL � Controlled Burn � Hood htsteMation � Emergency Generator<30 kw � LPlNatural Gas-Installation � Emergency Generator>30 kw �LPlNatural Gas-ANNUAL Sale � Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL trly Semi Anl Other �}- f ��j � Sprinkler � ❑ ❑ ❑ B � Recreational Burn ZJ- / � � �r , « Fire Aiarm � ❑ ❑ ❑ � � Sparklers Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations � Hood Suppression � ❑ ❑ ❑ � Standpipes(Sprinkler Sys) ��(„/� � �C.7 Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL Fire Works � Flammable Application-ANNUAL Valuation of Project � Fuel Tanks Q Other� Contractor '1 ' Company Signature Registered Y!N Fee Current Y/N Address License# ELECTRICIAN Company Signature Registered l�/N fee Gurrent Y/N Address License# PLUMBER Company Signature Registered Y/N Fee C:urrent Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# OTHER Company Signature Registered Y/N Fee Current Y!N Address License# Directions: 4 Fiil out application completely Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanical work over$5000) Supply two(2)sets of drawings with applicable documentation Allow 10-14 days for review aker submittal date. Parcel#-obtained from Property Tax Notice(http:!lappraiser.pascogov.com)