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�� � ���� <br /> ' 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received /`� �� Phon ntact for Pe rm�t ��� _-`j � �� 1 l l' 1 1 \ 1 <br /> (�f + ��SL-1 L�..LL.LIJ <br /> Owner's Name � Owner's Phone Numt�er � � � <br /> Owner'sAddress � G�� 32��`?�� <br /> Fee 5imple Titleholder Name v� � YT � ( TiUeholder Phone Nu nber C� �� � <br /> Fee Simple Titieholder Address <br /> ---� <br /> Job Address �j �"'�' h� I I� (�_..�„ ��:3 S� Lot# �� <br /> �J <br /> Sub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUA� � Hazardous Material(ller II or RQ Facility)ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hood Instaliation <br /> � Controiled Bum a LP/Natural Gas-Instal ation <br /> � Emergency Generetor<30 kw � LPlNatural Gas-ANNUAL Sale <br /> � Emergency Generator>30 kw � Places of Assembly-ANNUAL <br /> ��Fire Protection Maintenance-ANNUAL � Recreational Burn <br /> � emi � er ❑ � 1 I <br /> Sprinkler ❑ ❑ Sparklers 1I � <br /> Fire Alarm � ❑ ❑ ❑ � � Sprinkler System Inskiilations � 1 <br /> Hood Cleaning � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> Hood Suppression � p ❑ ❑ � � Torch Roofing/Tar Kettle <br /> � Fire Alarm Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works <br /> � Flammable App�ication-ANNUAL � Valuation of Project <br /> oFuel Tanks <br /> Q Other• <br /> Contractor � <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address ��/J �y �,, �j-' . �C� � '� License# �— <br /> ELECTRICIAN Company <br /> Signature Registered Y/P� Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address � <br /> 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 License# <br /> Directions: <br /> Fill out application completely <br /> Owner 8 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 /> Ailow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice i http://appraiser.pascogov.com) <br />