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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received �P —��� _ Phone Contact for Permit ,���y� <br /> �,�_-.�-a_„-�-..____....._.___�___-_,_ .___.___._...�..�.._..,..___.m.a._ _,._......_.......�....o..._ .�..._�.,.^.._.___._.__._.__._...__ _�-.- --- <br /> Owner's Name aK,C Q�lL�,s'F !� vn) Owner's Phone Number � � � <br /> Owner's Address Fj 1 I � V <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> C.°.:_.�__.�...._..r - _ �_...._... - �y_._,�.�.�.�._..�._m.._.a.�.., <br /> Job Address • - Lot# � <br /> Sub Division Parcel# <br /> ��.--_ .,. - _._.,._.,.� - - � � - .,.__._..��_ . �.- - - - �-�-._____a��,..._.._a -_�,..._..�.._d�°v.°�—e-�-.....--.� <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 � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> t y emi �n t er �`.�� <br /> Sprinkler � ❑ ❑ ❑ B � Recreational Bum J � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Instaliations <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 � �5"p0°— Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> �-�--- - -..,_a w..�. .� -- --- - ..._....._.._-_�.�....,__ �..�_._... -- ---- - <br /> Contractor Company L�C6LZS�j Q <br /> Signature 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 /> �~....� ,—�__..�._._.��._. , .__...,-_.�..�.�._...._�_.�.,__.._�.._...__..,_.J._,.v �..�..a.,_.....w.._.w��_..,_;:��-v....:.__._,_.__�...�.a_.._�_�____._..,._..�_.._.-.e,.._---_ _�,..-___�,�_.:n.. <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 /> C p�.etJ. �35�- 2t3a - 03J� <br />