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� a�saso-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> • Permit Application <br /> Date Received ,.FJZ��f'Y( ' � �l/ Phone Contact for Permit � � �� <br /> ' � � � <br /> Owner's Name �, Owner's Phone Number <br /> Owner's Address �~ � S . . 2 <br /> Fee Simple Titleholder Name Titleholder Phone Number � � �1 <br /> Fee Simple Titleholder Address <br /> ���"��. .K�. � ".x?:`': .,°� ���? ;r ,`� v ,. <br /> +�_�"- .�ati«x. �"� �;%;.t._���:,�: <br /> Job Address � • 2• � � <br /> Lot# <br /> Sub Division Parcel# <br /> r, . ..��:;,��:;, ::.� ,, .. . . �..:���°.�„�r: �--.���,. -�.�. ., . .. �.°�- .�. �.c.s._ ,�a_. .�.� .t�s,; �.. . ��s:� .� :�,h�; <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier 11 or RQ Faciliry)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> _.._.. <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> tr y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ � � Sparklers /� �� , <br /> � <br /> Hood Cleaning � ❑ � � Sprinkler System Installation <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 /> Other: <br /> -'. . Ea��g-, _. �-z:., . . :.°' rh..-,.. :..,. �,,.. .9� r�.:.':.,°:,, . s'a�=;�..'s ;' � _ . . >. . . .. .'.�`f ... <br /> i� <br /> Contr tor Company <br /> Signatu Registered Y/N Fee Current Y/N <br /> Address 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 /> � � . . _ , ..�,r- �. <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 /> Suppiy 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 />