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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> , Permit Application <br /> Date Received Phone Contact for Permit � � � <br /> r.--�-�..�_�.______i_..__v...._._.. �__�__..__._��__r��______-�w - __.._�.-��..�. �_ _._.__---�-=------____.�.�__..._..�-.,�._..a.._..__-_...-._.�r.__�,.. <br /> Owner's Name �� �n.� � S 14 ✓`� � Owner's Phone Number � � � <br /> Owner's Address 'CT�� 't�- s�F- -, <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> �:d��--w�=:.�� - - - ----- - - - - - - -- - - - - -- - - - - ,._ -�.., <br /> Job Address Lot# � <br /> Sub Division Parcel# <br /> ��,�� _�..._.�__.._��._.�....e�_._._.._,_�,..____-.._. __...a..��__._:--__...,�._ � _..�v.�....�._v_�...�.v.-�-��_,_..._�_ _�..._��a�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-AIdNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � <br /> t y emi �n t er /�� <br /> Sprinkler ,�❑ ❑ � � Recreational Bum S <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleanin ❑ ❑ ❑ in I m In Ila i � <br /> g � � � Spr k er Syste sta t ons / q <br /> � � l <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANIdUAL <br /> � Fire Works <br /> � FlammableApplication-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> �.��__._.._.__�.._ - �___m�___. -- — - -.�.r____..�_.._--�--�..J_._.��__._�-�__.- - --=____�-._.._��: ..___��..._�.�. - <br /> Contractor � � Company �� r4- �DK s4 ,�a2.e � r� <br /> Signature � Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature r 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 /> G-T- °- --- ---- ---- - -- --- -- <br /> ..___�__;�__...._.._.... ._____s_._�_z..�_,___ __-- . ' --_"'�-- ._,_----•-.--_:_-------�__�_.._...a__,.-- --• -- --_..ea_..-_____z. <br /> Directions: - � --° ---°�-- ------•-_w.__ _____�.._�_ <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 />