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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> 813-780-0020 Fax-813-780-0021 <br /> Date Received 07/14/2015 I Phone Contact for Permit 813 247 4 4777 <br /> .�._�.��._lr�._..��..._..�....�.....�... - .�_e`.v��a.,..._.ar�.+�..�.��d�.`�.�...����.�........u.�.4.�....�_�__�.��...�_._..__�..�� ..�....�.�.�_..��._�....d�LL._..x..�_..��..�....�e.J <br /> Owner's Name Moss S Ardell Owners Phone Number � � � <br /> Owner's Aiidress 19469 Count Road 460, Moulton, AL 35650-7339 <br /> Fee Simple Titleholder Name ; Titieholder Phone Number � � � <br /> Fee Simple Titleholder Address i <br /> ______��..._�' _ � ---�-- _ ---�-- _ __.___.__ �� <br />' Job Address � �38444 5th Avenue Ze�h rhills FL 33542-4328 � �oc# ` 4� <br /> sub�ivision Parce�# 11-26-21-0010-16700-0010 <br /> � <br /> �-:�_.__.�._. ..�..�.� - .....�_..,_..W.:�._.._._._.__.________�.._.� - - ._.,.v�....._. _ _ .___�____� d.. .� <br /> � Bio-Hazard Waste Storage-ANNUAL � � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> I <br /> � Controlled Burn i � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw ' � LP/Natural Gas-ANNUAL Sale <br /> I <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> try emi �n t er <br /> Sprinkler � ❑ ❑ ❑ � � � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br />� Hood Suppression � ❑ ❑ ❑ � � � Standpipes(Sprinkler Sys) <br /> � ire Alarm Installati� , � Torch Roofing/Tar Kettle <br /> �—flre u� ; � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL 'I O SOO.00 Valuation of Project <br /> � I <br /> Fuel Tanks <br /> Q Other: <br /> L ......��...�..�y.��.�..,���.,��..,.�..s� __ _ �.�...v....,....�.....�..�.�......�. .��... ,re,.`.�e.,.........�.....v...»y._.�.�..�.......»w....�. ...��.�....�......�. �.e...,w..�e��...� � <br /> Contractor ; Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address j License# <br /> ELECTRICIAN Company <br /> Signature I Registered l�/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 Ric ard R. Swilley-S ndra C. Cre s, Agent � Company Cox Fire Protection, Inc. <br /> Signature p Registered Y/N Fee Current Y/N <br /> Address 7910 Professional Place,Tam a, FL 33637 I License# EC13004651 <br /> -- — .^.�_.�.._....._._�...�_�._..��_...w�_.__.e_�..�._..�._�__._.___._..._____,.__---°-�°----_.----..�.�.____.�.w___q�..,_.._...___._.�_____..._�_=-:�...°`� <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 />