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s�3�so-oozo City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit � � � <br /> Owner's Name t�L Owner's Phone Number � �O`t2 � <br /> Owners Address , S � ,�`} .� � <br /> Fee Simple Titleholder Name Titleholder Phone Number oU^U � rl�g <br /> Fee Simple Titleholder Address <br /> ., ..- ': . ,,...r i� >.�`�;,.:�. . ,x�:",�t �-.:.:�: » .�.::,:....�`.':�;r"R-F..;w�'"„- �'. ...�,��_��. .._ <. ::;..s �',.':-:� . ;F'�;'< , .•-'€�", ."� <br /> Job Address j `� ?j � �� `��,' tq Lot# � <br /> Sub Division Parcel# <br /> �. �-s _ . .,�,� �����. � . _r..���.'�� ..�.��. .�a.,�u��ru, ., . �;a,� .s. .�. _.. x=.- : <�:; . _ �t� ;.���,k� <br /> � BiaHazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier 11 or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LPJNatural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> ry emi �n er <br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum � / <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � � v / <br /> Hood Cleaning � O � 0 � � Sprinkler System Installations � <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch RoofinglTar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> aFlammabieApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Other: <br /> ��� .�.,: �--� ��� �--�� � 4n�� . <br /> .-, u �� . _ - <.,� <...�_ �_ � � ,.,�: _ = �.-.: - ., �;�.� ,�;,� �,. <br /> Contractor Company (�(�,�, Q��(�Q/�- <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 <br /> Signature Registered Y/N Fee Curcent Y/N <br /> Address License# <br /> �, <br /> , �,... ..�. <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 appiicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />