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813-780-0020 Ciry of Zephyrhills Fire Fax-a�3aso-oo2� <br /> d ' Permit Application <br /> Date Received� Phone Contact for Permit � � � <br /> -- ___,�___ ___ _._____.___ __ __.--- �-. - - - - <br /> �..� _.____ u_..--- .a._------°--________._,_.�:.___ _.��,....�.m_ _ .__ _ -- - -- - ___-° --�_�.,....�_ �-� ___a.m__,....,�..r___, <br /> Owner's Name ,� pP� ���� µ Owner's Phone Number g1,3 � �,j�' <br /> Owner's Address � �� �� <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> ------_._.,_.._._�_..__.._,_�r.,_��_.-_��...�.__u._.w.__��--�-.-- �.--�..._...,-....�.�,.�. __.._____�. - -- - - - <br /> t�.�._----A_. . _.�__---,__ _____ .__� .�__._....,,.�.._, v <br /> _..T�__=_n�.__t-----_......._�-_...._ns.___._____._..�_.�..-----___—__.___...�.�----------------�-�.•�.._>_._____._..-_.<,__�___..�____.�.__.._�_..�M��..� <br /> Job Address �� /� �7 �� Lot# � <br /> Sub Division Parcel# <br /> e�.--�___�_.._._.�.m�.=_...._...�__�_��____...�_�.___��M�.:....�__�-�m-Y_.._��._�__�:_n ��_�..:._._._V-..�.-__._e----�__�_ w.�_ � __.._� <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANPIUAL <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 /> t y emi � t er <br /> Sprinkler � ❑ ❑ � � � Recreational Burn <br /> Fire Alarm � ❑ ❑ �. � � Sparklers <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 /> � FlammableApplication-ANNUAL Valuation of.Project <br /> � Fuel Tanks <br /> Q Other: <br /> r___.�_��v.�____�_._�. - - - - ��_�.�,����. -- - _____...._.�.._.._-- ----_.__,.�.__a___=___�-- _ _ --- ____._�..�.�-..__..�_._v_�.,��-� <br /> Contractor �— � Company ,�� jre <br /> Signature � ��� Registered Y/N Fee Current Y/N <br /> Address Q � T,r o ,3 License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/�l 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 Current Y/N <br /> Address License# <br /> r��.----- �.._ . -- <br /> .______.w_ _... U,. .,.:.. ..._._._..�„._,�.__..__.__r._ .._._- .,. _,_._�__..MU_ .�_..r_..�_.._._ .__._. - _.__ .__--.____w__._.. . --°° -.,. ...�--. �. <br /> Directions: --.---.-__....____ -a.____,.. _ <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 />