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a�aaao-oo2o City of Zephyrhills Fire Fax-813-780-D02� I <br /> I Permit Application <br /> Date Received , Phone Contact for Permit '�(3 �a � (3 'rJ 7 <br /> r- - -..__,.-_.-..- - ,. -- -- --- � -� �__......�__ -�-.c_==='�:�—---=�--'--�_�__�-�- --- �a-��r',___� -_.__: �-..-�- s - � <br /> Ownets Name C.,��C-7�" C�'2'� �� (7 ��C' Owner's Phone Number �S(�n $3�a 3oZv�d <br /> Ovmers Address. �a 8�- �'!a � �� S�V j�"��K� ��� ��a-�«a <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> �:=_"_,. ;-- -_..�- - --- -� � -=��'�'==Y�-��;-:-r-----~a:-.�;�,,,.M—�:'^': ar-.`�=�::�,�'n_•-�="'- - --^s��_�_.�_'s - _ - ;�..�:�.',_..__`°��z'--�"�`.• <br /> Job Address �S�� J ��FLK E � 5��"i '/�_ ,s^� c Lot# � <br /> Sub Division Parcel# �� -�G-�I -�IG -(53�GO'—�� <br /> t_z.:.-: _.�._.�_�_ ..�,�-,...��_____-R.___.-_ -�,,.r�.�;-_.—._..�___- �_--__-.,.��--.�^,�_,��_.....;-�:.�--��_-�—�--->-�:-_--..__ -�-H.,•--�- �;_�.- <br /> � Bio-Hazard Waste 5torage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � �Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � 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 � 5� <br /> tr y emi �n t er �� <br /> I � <br /> Sprinkler � ❑ � ❑,_� � Recreationa Bum <br />� Fire Alartn � ❑ ❑ ❑ � ,� Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <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 Valuation of Project <br /> � Fuel Tanks � <br /> Q Other: <br /> �- -=-^ - ----�'_-- -—�.:�=-- ----.�.. _�.----...__:. �__�__.�_______..._. .�.;_:�:-..r—_.- _---•-�------ -.::_._.���_�- -- __--__-______:.-��.�---___-=- <br /> Contractor � Company C�}�� �J�2.E S�2�NK(,�,25 /Al1C. <br /> Signature Registered Y/N Fee Current Y/N <br /> Address ICx7 � �Ci+4r�W4-�/ ��s'v( C lf)/�7�A- F�- �icense# '���/^C�i��� <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 /> i OTHER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> � - " _- _ - � - - -- - , . - . .. .. _ -= -� - = --�- ----- - - . _�_ ._ . . . ._ . ._ ,-_._. - - �-.-- <br /> Directions: <br /> FII out application completely. <br /> Owner E�Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> if over$2500,a Notice of Commencement is required(Mechanical v✓ork 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(httpJ/appraiser.pascogov.com) <br />