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aisaso-oa2o City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application - <br /> Date Received '? -4' . _ti� Phone Contact for Permit ' <br /> �,.,a,._,.�„a : �� �� �,_ :� <br /> Owner's Name �o\�o�-. LoC l�-� Owner's Phone Number ` � 783 p� <br /> � � � <br /> Owner's Address 9 S� �y\l �` J � �� L— <br /> �;. <br /> Fee Simple Titleholder Name �� �� � <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address �J <br /> s ,:,,F : .�, <br /> Job Address � <br /> Lot# <br /> Sub Division <br /> . .z,�.w, <br /> Parcel# <br /> � � �,.. �� -•� :� a , <br /> . .. . .... ,, n:.;•5. e�r�.:<< ..� .. ..�... _._. .._ ...._. <br /> � :. .- . .. ... ..:. ...".:' , ..�.�:; . �s 3 ':fi� �."$,,. �:.,, . ;.. .�,,...'. a* ��.-. . ... . <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 /> ❑�y emi �n er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � r—, ❑ / ��� <br /> ❑ ❑ ❑ �_� Sparklers � �j / <br /> Hood Cleaning � ❑ p � r� ❑ �� �� <br /> L Sprinkler System Installations <br /> Hood Suppression � ❑ �[ ❑ � � Standpipes(Sprinkler Sys) <br /> 0 'y�=-� ip—, <br /> Fire Alarm Installation a Torch RoofingRar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> aFire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> QOther: <br /> . _ , . . . ,�,. �... <br /> Contractor `` � <br /> Signature Company ,•�.G _ � ` <br /> Registered Y/N Fe Current Y/1�I <br /> Address P c�� /j� $ (� 3 License# <br /> ELECTRICIAN <br /> Company <br /> Signature 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 /> Company <br /> Signature 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. Parcei#-obtained from Property Tax Notice htt //a <br /> ( p: ppraiser.pascogov.com) <br />