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813-780-0020 City o#Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received � Phone Contact for Permit � � � � . .. .. . ..�- . � . . . . . . Owner's Name ( Owner's Phone Number � � � Owner's Address � (1� Fee Simple Titleholder Name Titleholder Phone Number � � � Fee Simple Titleholder Address Job Address Lot# � Sub Division Parcel# 3 - - -��U -�J (� � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood7Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL � Controlled Burn � Hood Installation � Emergency Generator<30 kw � LP/Natural Gas-Installation � Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sale � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL v ❑�y emi �n er ❑ � � Sprinkler ❑ ❑ ❑ Recreational Burn i I I,� "! Fire Alarm ❑ ❑ ❑ � � Sparklers � Hood Cleaning � ❑ ❑ � � Sprinkler System Installations ` Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Ketlle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Worics � Fiammable Application-ANNUAL Valuation of Project � Fuel Tanks Q Other: Contractor Company i� Signature Registered /N Fee Current Y/N Address License# ELECTRICIAN Company Signature Registered Y/N Fee Current Y/N Address License# PLUMBER Compa�y Signature Registered Y/N Fee Current Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Cunent Y/N Address License# OTHER Company Signature Registered Y/N Fee Cunent Y/N Address License# Directions Fill 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 after submittai date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com)