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5 � o �� 3o c$q <br /> � �sis�so-oozo City of Zephyrhills Fire Fax-813-780-0021 <br /> � Permit Application <br /> Date Received Phone Contact for Pertnit � � �� <br /> Owner's Name �� � Owners Phone Number � ��'f� �� <br /> Owner's Address ��� �' � '�.. � l�(� fd r'�.'!"� /TV{ �Q�'�1/� �('� � a �� <br /> Fee Simple Titleholder Name Titleholder Phone Number � <br /> Fee Simpie Titleholder Address <br /> Job Address � � 0—1 Q<< �1� (Jl Z,.�Q r �1�IS �L, �35 Lot# � <br /> Sub Division Parcel# <br /> i <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw Q LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw �^/LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL �Places of Assembly-ANNUAL � <br /> �y emi �n er � , //�/� <br /> 1.���_r`� <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum � � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar 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 /> , r� <br /> Contractor , '��C mpany <br /> Signature � �� � Registered Y/N Fee Current Y/N <br /> Address (,v V/� �'Y�� (� � � 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 Curre�t 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 /> 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 Mro(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 /> �-�-n: � I d�'n �(,�' <br /> � 33 <br /> S �`� �5 <br /> 2.� hy rl'1��l l S� �L. �!Z <br /> 1° �35 <br />