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s�3aeo-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> � � z Permit Application <br /> Date Received ��� Phone Contact for Permit A�N� � <br /> . <br /> ��._..._._----- - --- ,Y..-- .._��___.�.� <br /> _.__V_.____y._.__._.___�__.._.,,____..._.�__.�._..._..._�-._.. ---- ----------._.�__..__..��.�,� _,_ . <br /> Owner's Name i � ( Owner's Phone Number �T ��� <br /> Owner's Address `�g � �'�/�� L- '�- �'�ji � � <br /> Fee Simple Titleholder Name ' Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> 6._'.�_..._.e._�.K�_ - -- - - - _ - - - - ._.� <br /> Job Address Lot# �� <br /> Sub Division Parcel# <br /> ��.v__._ __._.�._._ A, r-.�.�.._.�.,_ --_�,_.._ �,w...��.�..-_�...�.�._.....,� _._._. - - ..,..�.v._.�__,..�...m_._._.__._�.._�...�..W�.�._..,..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 � LPlNatural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> t y emi �n t er � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ O � � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing(far Kettle <br /> � Fire Pumps � Waste Tire Storage ANfdUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> �;:.��_._.._._.__....�� - �...� --- _�...4._..n._.___ — _ �..�.....���._r _.�_.w_,�����,�,�.°�-,.F.w._.._�.._.___ ,.�..._ _..,�e_._�.:_.�._ <br /> Contractor � Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address �� � z License# � <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address Cicense# <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 Current Y/N <br /> Address License# <br /> �...__. _._ - - <br /> �_..�_�___ _�,�._. ._'__ .� ......_...r._ ,=,____.,.. - ` - -�- - -� --___._,___ ..,._._a__�-- __.___ _.__ _...---_� <br /> _ — _ _. __ -...___ _._..___, ._---__�._,....z_ ___.,��._.:__.._�• .. . - <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. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />� <br />