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813-78Q-0020 City of Zephyrhills �ire Fax-813-780-0021 <br /> „ - Permit Application <br /> Date Received Phone Contact for Permit � C� � <br /> Owner's Name Z� �1- �;1� �,/� �-�(Z Owner's Phone Number � �� �� <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number [� � � <br /> Fee Simple Titleholder Address <br /> �J <br /> n -� c. � ,• .-- <br /> JobAddress � 2(��^ �'�, <br /> Lot# �� <br /> Sub Division Parcel# <br /> . , , �s, , . .. _ _ _ ,; �.;,.,.. <br /> u,�_ :� y ;�. ., <,� ,.� , �, ; .,,; <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or Rc]Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw a LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ❑� emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> FireAlarm � ❑ ❑ �� � Sparklers �� ��5�3 <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 /> Q Other: <br /> � �=� � ,�,. <br /> . �r�-. �.._ ,_ t v . .� <br /> u. . _, . _ -, . � _ . <br /> , . � <br /> ;, .. ,.. _ <br /> . � <br /> Contractor Y .� <br /> 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 <br /> 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&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. Parcei#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />