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813 78o -002J City of.Zephyrhills "Fire. , j 2 t S Fax-813-780-0021 <br /> Permit Application j -t <br /> Date Received Phone Contact �, 1 .._ <br /> �,,... ..:: JJ <br /> ( ++ j Contact for Permi Z. 5 ,� � �7i5 <br /> Owners Name l , Y � o( � \\ 11`a ` 2, 1� Owner's Phone Number <br /> Owner's Address �� � ` � (y ) }t� � t J \�11� 1 )' ) �� <br /> Fee Simple Titleholder Name ` J Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address ' ������ + �`lL' ( \1 'r\I\A\ \ )5, L-1L Lot <br /> Sub Division Parcel # 11 2 Ip Z I -J/( C/-It a <br /> Bio- Hazard Waste Storage -.ANNUAL Fumigation Tent . <br /> I I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Controlled Bum . Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I — I Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> I' Isemi1 17171 1 utner <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm ❑ ❑ II! 1 . 1 I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I ( I Standpipes (Sprinkler Sys) <br /> I 1 Fire Alarm Installation Torch Roofing/Tar Kettle <br /> n Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ` I Valuation of Project <br /> Fuel Tanks <br /> 7 Othe • I I <br /> Contractor 1 / Company C m2 Vr M,� <br /> « K i re °' COM; :('(It∎relN k C <br /> ;♦ice, A <br /> Signature a: ' Registered N Fee Current I Y / N <br /> Address I <br /> 1 1 License # 1 E �O( <br /> (( 5 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I 1 License # I I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N 1 <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature . Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> zioneen License # a=zz <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 /> . (.0)61 <br /> a`� q�� p � <br />