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813 -780 -0020 City of Zephyrhills Fire. 4 c6 rb' Fax -813 -780 -0021 .. <br /> Permit Application _ _ _ <br /> Date'Received - - Phone Contact for Permit <br /> Owners Name f I L SQL \Z-V43(2 1 Owners Phone Number 3 J r. i I f CL <br /> Owners Address 1 So \Z OD OAX G\Or.Q 7. wiZ■i:.lk , 1-•- I <br /> Fee Simple Titleholder Name 1 I Titleholder Phone Number I 1 1 I I I <br /> Fee Simple Address I 1 <br /> Job Address Lot # I <br /> Sub Division 1 1 Parcel # l I <br /> E Bio Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> ED Controlled Bum n I-Iood Installation <br /> n Emergency Generator < 30 kw n LP/Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP/Natural Gas - ANNUAL Sale <br /> I - 1 Fire Protection Maintenance - ANNUAL n Places of Assembly-ANNUAL <br /> ® E I 1E9 ,� <br /> Sprinkler Li ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 0 Sparklers <br /> Hood Cleaning ❑ ❑ J I El Sprinkler System Instatiations <br /> Hood Suppression LJ ❑ ❑ ❑ 1 I n Standpipes (Spy Sys) <br /> n Fire Alarm Installation Torch Roofirrg!Tar Kettle <br /> ED Fire Pumps Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL ( Valuation of Project <br /> Fuel Tanks <br /> El Other. I <br /> Aningasommemeammrarsamm <br /> Signature <br /> Contractor <br /> - . to. A Registered Y/N I Fee Current I Y/ N J <br /> Address S t... - . _ I C L_ _ _ — a I. License # <br /> ELECTRICIAN Cody <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 ( Ucettise # I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address 1 1 License # 1 <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License* I ( <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Curerd I YIN I <br /> Address License # <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 (httpl /appraiser.pascogov.com) <br />