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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Appiication <br /> Date Receivetl ' Phone Contact for Permit � � <br /> � _ . ;.:: , . .: - < : <br /> 4 <br /> Owner's Name , Owner's Phone Number � ��.� �'�g� <br /> Owner's Address � � (� ��� <br /> Fee Simple Titieholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> F� .. . .. . . .a e..,_, .. � . .._... . -. ��_y.�.� .,... ..M, <br /> _ . - �Ei_ '"'3.' 3b;�. _. '�ih;�.��w. <br /> Job Address � <br /> Lot# ��� <br /> Sub Division Parcel# <br /> p . , . <br /> , .,,, _;, .,_�, _ <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 � LPlNatural Gas-ANNUAL Sale /l � <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � ��� / � <br /> �y emi �n er � <br /> Sprinkler � ❑ ❑ ❑ B � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations 2 � <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 /> Contractor • Company '�n (� (� <br /> Signature ` Registered Y/N Fee Cunent Y , <br /> Address p � �-[,� � � � License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Cunent Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> 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 <br /> License# <br />{Directions: <br /> Fill out application completely. <br /> Owner 8 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 />