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sisaso-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> . w Permit Application <br /> Date Received� ��G–��� Phone Contact for Permit s— � <br /> --r—�_,.. <br /> Owner's Name °i�`��J /�n� Owner's Phone Num r f1�3 �j"y' �/y� <br /> Owners Address SV'� � r1✓I e� u�,��,d,�� f � 53.�'�y <br /> Fee Simple Titleholder Name Titleholder Phone Number �� �� <br /> Fee Simple Titleholder Address <br /> �J <br /> ; < . <br /> Job Address (� � <br /> �Jr G 1 '✓ �v � �,e ' r � , � 3 3 S�I Lot# � <br /> Sub Division Parcel# <br /> ,..,- . �., �: �.� � . <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent ` ` 4 <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or Rc�Facility)ANNUAL <br /> aControlled 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 2 <br /> ❑ IfTr y emi �n er ❑ �/ �U J I <br /> Sprinkler ❑ ❑ ❑ Recreational Bum f <br /> Fire Alarm � ❑ ❑ ❑ � � 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 �_—� Valuation of Project <br /> � Fuel Tanks <br /> QOther: <br /> , .. _. <br /> . ..-_ _� .. . � � ,. - <br /> �- . .:_ �_>��_ . <br /> ,.� <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/1�I Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company �— <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# � <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> Directions: - _. , , , _ . <br /> Fill out application completely. <br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signed contrect 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 PropeRy Tax Notice(http://appraiser.pascogov.com) <br />