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ai 3-�so-oo2o Ciry of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received � � � � Phone Contact for Permit 'l�j �S ( � <br /> , . _. _-.,. _ ..... .�.7 <br /> Owner's Name �-}�o � �.��G� Owner's Phone Number C� � � <br /> Owner's Address ���z 1/�.Q.f1Cy4y�.i-��-[_ C-�— ���q�- ��..� � �� <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � � <br /> Fee Simple Titleholder Address <br /> a � ��.-.< < _ . <br /> . . .. . ..,., r .-_.. ;, � ,.. d .a;:,a +c<.. ,.,5 �,-.,, .,�„�'- .n ..t.`z: >,.. ..+�.��� ..�..... �}`' 5.�... .:,�a»{:.: y3g .r,x�..:w:. .. <br /> - �� . '��?X.'3.'�z"$�.»w�u,ti:'�:: <br /> Job Address � �� l l � t 1� �IQ�, i 3�� Lot# �� <br /> Sub Division Parcel# <br /> . ;.; , ,. . - . ... .. ..... ..... . _r �:� a,��,.-: <br /> Q Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier il or R�Facitity)ANNUAL <br /> aControlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LPlNatural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL q <br /> �y emi �n er ��� l <br /> Sprinkler � ❑ ❑ ❑ S' Q � Recreational Burn � l <br /> Fire Alarm � ❑ ❑ ❑ � Sparklers <br /> Hood Cieaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> aFire 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 /> : � <br /> Q Other: <br /> ,. ;..,F . a� 3� ,-�=:. r� �. : ,� <br /> � . ,� � . . ,__ . _, � <br /> Contractor Company ,`a,��. '. � 1 D <br /> Signature Registered Y/N Fee CuRent Y/N <br /> Address License# <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER <br /> 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 <br /> Company <br /> Signature Registered Y/N Fee C:unent Y/N <br /> Address License# <br /> Directionx <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(http://appraiser.pascogov.com) <br />