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813-780-0020 City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received �Z—� Phone Contact for Permit 8l� 78 <br /> . _ L .s'O! <br /> Owner's Name J- �/p ��y S' Owner's Phone Number � � �� <br /> �7 ���J <br /> Owner's Address �J 7��..� S,� ,S y Lt� <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � � <br /> Fee Simple Titleholder Address <br /> Job Address J /Q.tit �- - _ <br /> Lot# �� <br /> Sub Division Parcel# <br /> �. .... ,�.� <br /> u . . _ -�. ,... ,, _ ._ ,_. .., <br /> � , y,,.�. . . . s� ,. <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Instaliation <br /> � Emergency Generator<30 kw 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 /> Sprinkler ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ C� � 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 QD Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> F r ::� �:� . - :. •:�. �.. ;, _ ,,. <br /> Contractor Company <br /> Signature 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 n rl.L.S p�e ,ro.-L 6,6se C <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# 3 � <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 />