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a�3aao-oo2a City of Zephyrhills Fire =ax-a�saso-oo2� <br /> Permit Appiication <br /> Date Received l Z"�j Phone Contact for Permit �(3 g �o .(,�b <br /> Owner's Name .f p,.��1� civ��-- FeS�. Owner's Phone Number ��3 7�`j I S $� <br /> Owner's Address 3� � I S ������- �v� �j,�✓�4�Z- <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> _ _ <br /> . ry . � �. , > .,,�. _ . �r s;, . .;- <br /> Job Address �cs-yv�-2� Lot# � <br /> Sub Division Parcel# <br /> � . .t.�. .._ , - . < < . � <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RC�Facility)ANNUAL <br /> � Co�trolled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation � <br /> � Emergency Generator>30 kw a LP/Natural Gas-/WNUAL Sale �`� " � � <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL '� <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Burn <br /> e. <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ � ❑ � � Standpipes(Sprinkler Sys) � <br /> QFire 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 /> � � v -..���. - _,,, , - � �� �� _. <br /> � �.�__. ... �+. �:�r. . _ _,. , , ,. _. <br /> Contractor Company ,-/�c, � /ri c- <br /> Signature Registered Y/N Fee Current Y/N <br /> Address p p g L.u.,d o` �l 6 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 Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> , _ x <br /> _ _ <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 /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />