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�. s�3aao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> �1� Permit Application <br /> Date Received Phone Contact for Permit A�`� � <br /> .�.._.._-----____... ----._._.._�___-______ _.a.._.....—..____�___ ...:.,.m..�.�_......�. <br /> �.�_-�._��_�__.__.�r.__ - �.._.�,.....�_._._.��_..__..„�_-.�____���_____-----_,___.. __�.- -.-_ ---_..�---_,_._�____._..__-,- <br /> �wner's Name ��' aG.!J GPdjod��OG �!/ �=����/ Owner's Phone Number � � � <br /> r <br /> J�wner's Address � ��'F�'� ��'��T� S'i��A� ���iT�/C��/L4.�� �L���J�' ��5�' <br /> i Ou0Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> �:.�,___r_4._..�.- - - - - — ---_____ - <br /> Job Address �Lot# � <br /> Sub Division Parcel# <br /> �.;r._.__.-�.._._.w.....w.._,.o��� - ___......._..r..__- .w�..,....��...�---..°��_.____.._..�.....�..�4�.�._.�.,.��.__ .v..�..,..a.�.:___.^........._.N_�s.��......���._,,q.._..._ <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 LP1N �LGas=ABIN Al.�al.e_ 1, <br /> � Fire Protection Maintenance-ANMUAL Places of Assembly-ANNUAL �'(,t,�f/` <br /> t y emi �n t er ' ______,_ <br /> Sprinkler � ❑ ❑ ❑ B � Recreational Burn /.e.,i' <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �¢,�' n/.`W <br /> �% V <br /> � Hood Cleaning � ❑ ❑ O � � Sprinkler System Installations � <br /> , Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) �( ` <br /> �i <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL V21U8tI0n Of PfOj@Ct <br /> � Fuel Tanks <br /> Q Other: - <br /> s��.v..._...;�__�.._.,.._..N ..�._ ____.,.�_...�.�_,.....�.F.:��.m.�.:,.�..L__...._.._...__.._,w....>.. __.�..._,._.;._......�,....�__...y,-._..�..�.�.�.--._...� - ._- _...�,x�..�._._.�. <br /> r tor y � Company <br /> ignature /3'L��t'� � ��1���� 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 Current Y/N <br /> Address License# <br /> r=-- ,�_�. �_ __.._...- -- _ ....�..,._a-_,__ : __.�._.. a.___.___.._,.._.,�..,�_ .___.._..,�..�__ .,,_.__.__ _..,..�_..._� _._a ,.._.._�_..._.___.,,._____..�.v._�.e __�._. _�.�.� __.F.___-,. <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 />