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813 -780 -0020 City of Zephyrhills Fire I si I Fax - 813-780 -0021 <br /> Permit Application <br /> Date Received 1 1 Phone Contact for Permit 1' - . f .) {- 1 1 1 -1:4-! 1 I o S- 6 6 I <br /> Owner's Name ) \ . r ' . \AJ c,A es( s \ \ . 1 Yv ,,,,. i C c �- t ._; . r-C,1 Owners Phone Number 1 H 1 1 I <br /> Owners Address 1 " '‘ 2. 4 5 (:) 4 S4 . . : l i i , % i & J - \ , I <br /> Fee Simple Titleholder Name 1 1 Ti ieholdes Phone %umber 1 1 1 1 1 I <br /> Fee Simple Titleholder Address I 1 • Job Address 11. A+ ?, 3 0 ,�t 044-k . J1.. ., p ',- ■ ‘ J 3 J ''i.. I Lot # <br /> Sub Division I I Parcel # 1 I <br /> Q Bio-Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> D Comm Exhaust Kitchen Hood/Duct Q Hood Installation <br /> Controlled Bum LP/Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP/Natural Gas - ANNUAL Sale <br /> - Emergency Generator > 30 kw o Places of Assembly- ANNUAL <br /> .p# Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> ®® LEI lOther <br /> Sprinkler El ❑ ❑ ❑ I 0 Sparklers <br /> Fire Alarm ED ❑ ❑ ❑ I [] Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ l I 0 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Insla Suppression ❑ ❑ tion I n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Appr— r. ' (AL" Valuation of Project <br /> Fuel Tanks <br /> Other: IIIIIi (� <br /> is ! <br /> Contractor Company J . 1 +- r - • . <br /> Signature 1 Registered Y / N Fee Current Y / N t <br /> Address License # 1 I <br /> ELECTRICIA Company I <br /> Signature Registered I Y/ N I Fee Current I Y/ N <br /> Address I 1 License # I I <br /> PLUMBER Company I <br /> Signature Registered I Y/ N I Fee Current I Y/ N I <br /> Address I ` License* 1 ` <br /> MECHANICAL <br /> 1 Company I I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER I Company I I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I I <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 wilt' applicable documentation <br /> Allow 10-14 days for review after submktal date. Parcel # - obtained from Property Tax Notice (httpilappraiser.pascogov.com) <br /> 6 Ck — .--A— 1 & S 'EN <br />