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o io-IoU-UU�u City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received Phone Contact for Permit ' Owner's Name Q [ _ Owner's Phone Number L Owner's Address 3W TIA fsemq Ary VG SvAe 400. l" 04a& TL 3.3 ci 0J Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address Job Addressi�V rh ( I I $ ; p 33 5 y ! Lot # Sub Division arcel # Tlazia WaA Storage - ANNUAL Fumigation Tent Comm Exhaust Kitchen Hood/Duct Hazardous Material (Tier II or RQ Facility) ANNUAL Controlled Bum Hood Installation Emergency Generator < 30 kw LP/Natural Gas -Installation Emergency Generator > 30 kw LP/Natural Gas -ANNUAL Sale Fire Protection Maintenance - ANNUAL Places of Assembly -ANNUAL ®y emi ®n Sprinkler ❑ ❑ ❑ Recreational Burn Fire Alarm ❑ ❑ ❑ Sparklers Hood Cleaning ❑ ❑ ❑ El Sprinkler System Installations r 1 Hood Suppression ❑ ❑ ❑ Standpipes (Sprinkler Sys) Fire Alarm Installation Torch Roofing/Tar Kettle aFire Pumps Waste Tire Storage ANNUAL Flammable Application- ANNUAL Zq2_5700.Clro I Valuation of Project aFuel Tanks Q Other: Contractor Company v e 4� r]tire q�+.A Signature Registered / N Fee Current Y / N Address License # ELECTRICIAN Company Signature Registered Y / N Fee Current Y / N Address License # PLUMBER Company Signature Registered Y / N Fee Current Address License # MECHANICAL Company Signature Registered Y / N Fee Current Y / N Address License # OTHER Company Signature Registered Y / N Fee Current I Y / N Address License # Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http://appraiser.pascogov.com)