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813-780-0020 City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received Z � L a { 6y�� <br /> . _ . Phone Contact for Permit �3l 3 �j y b <br /> Owner's Name S o�'N�'� �S �� � <br /> O w n e r's P h one Num ber �� � 7 g Z L.�2 7 Z <br /> Owner's Address �y � � ���` <br /> T3\� � 2.�_�, -t ti<< 3"3 s�2_ <br /> Fee Simple Titleholder Name �� ('—'--1 � <br /> Titleholder Phone Number I I <br /> Fee Simple Titleholder Address �—�•� <br /> Job Address S o_.rv�-�._ _ � Y :.. _ <br /> Lot# � <br /> Sub Division <br /> _ t �, . •: �.. ,�, � <br /> Parcel# <br /> � , ,. ,,, : �-, ,;:,y,. . , r <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 Installation <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 /> a rTy emi �n er ❑ - <br /> Sprinkler ❑ � ❑ Recreational Bum � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers f `� � <br /> Hood Cieaning p � � <br /> � � � � Sprinkler System Instailations <br /> Hood Suppression � '$ � ❑ � � Standpipes(Sprinkier Sys) <br /> � Fire Alarm Installation � � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> � � � , ._ <br /> . _ ,.�, �.. <br /> �.,_. z_ .. u_. <br /> 3a, , .. ., ,. . , <br /> �� � � °P� . ,,.� <br /> .���.4�k h <br /> Contractor �,.,.� Com an '_ � � <br /> Signature 4 p y �����- ��' fr-� /n G- <br /> Registered Y/N Fee Current Y/N <br /> Address P,�� p �S �� <br /> �o License# <br /> ELECTRICIAN <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER <br /> Signature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> „_, _ License# <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 /> 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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />