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�813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> )ate Received �- � Phone Contact for Pertnit <br /> e wn. ... _.Y .. :ti?Y"'�^-d�F'N'�+tirvo'>«r-s��,.q'Y,R.rt„a e. 'as4e..e'9m<-ss.s, ..zw ,�y' _ _ 'rR . . . . - <br /> hnner's Name 1�.- �^�� ��1.1 (� U r Owners Phone Number � � � <br /> hvner's Address �l 3(,� G od�(/t �v,(1 f '/.J �� 3 3 S y z <br /> �ee Simple Titleholder Name Titleholder Phone Number � � � <br /> �ee Simple Titleholder Address <br /> � ,�n•.�r� �r��s <br /> iob Address Lot# � <br /> >ub Division Parcel# <br /> � ' F'R a;evc"<`��w`:':.__ _ , t'�T-""e'_ . <br /> _ _ _ �",^R: _ <br /> QBio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> o Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Naturel Gas-ANNUAL Sale <br /> aFire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> � emi � er <br /> Sprinkler � ❑ ❑ � B � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers / <br /> j� �� <br /> � Hood Cleaning � ❑ ❑ � � Sprinkler System Installation 1 r� �� <br /> /"`+' ��/ <br /> Hood Suppression ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � l <br /> � Fire Alarm Installation a Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q other: <br /> a, ,.. �:�;.�- � w�,� _ ,.�����,�. � <br /> Contractor ' -�,,,. Company u� (NJdd-j�`��2 �tZ��G� <br /> Signature /"� '—' Registered Y/ Fee Current Y N <br /> Address J� f'w.aT,p,, !�(,u a 2 ��' .3 �t r License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current 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 <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> i License# <br /> Directions: <br /> Fill out application compietely <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 />