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813780.10020 City of.ZephyrhillsFire. Fax-813-780-0021 <br /> Permit Application <br /> Date Received , 1 Phone Contact for Permit Z , - -152, <br /> Owner's Name 1T kv C <br /> r ` r rit_, 'r \ 4 C_- + Owner's Phone Number <br /> Owner's Address �U�� Ub,r� r ., ( l�til \ ` 3' * <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 <br /> Fee Simple Titleholder Address <br /> r5�td�@ "�kr4+'°S ..d X+_�. �a"`as•S+.ka+'z asa.c _ .... -r -... ., . , <br /> e tea; <br /> _ �l .0 ( C i -/ i a F <br /> Job Address )1-II Lot# <br /> V iA . J "� E t �' A , ..2_ -ti c \ \ k \ 7 5 � • <br /> Sub Division Parcel # \ 1 (,„ Z I - c' c i(. ( (i ( < i ) <br /> n Bio- Hazard Waste Storage — ANNUAL n Fumigation Tent • <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum ( I Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 1 Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> 72 Fire Protection Maintenance - ANNUAL I ( Places of Assembly - ANNUAL <br /> IUtnyl lbemi1 Other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm if% ❑ ❑ in 1 1 1 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I ' l Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 -I Valuation of Project <br /> n Fuel Tanks <br /> n Othe� �.�_. <br /> Contractor A Compan (.( l'I.r ri1' l v( " ('a C64. y S inl, 1 <br /> Signature Registered tr/ N 1 Fee Current Y / N <br /> Address I I 1 License # 1C r (i , - <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N <br /> Address I License # <br /> PLUMBER Company 1 <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # 1 <br /> MECHANICAL Company <br /> Signature . Registered Y / N 1 Fee Current I Y / N <br /> Address 1 I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <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 (httpi /appraiser.pascogov.com) <br />