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813780 -0020 City of. Zephyrhills'Fire -ft 'I 5 (1 0 Fax- 813- 780 -0021 <br /> Permit Application . <br /> Date Received'P 45 r Phone Contact for Permit (.3 Sµ <br /> � 1 `,x,3.5 / <br /> Owner's Name L 1.9,52L0 /" ✓ elL - - Owner's Phone Number ( 1 3 -5 • 93-57 <br /> Owner's Address PO 0 % 7M /i /')Y: "/ 2_ 3 ! <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> „�.� s•: r.. se nt4 - -r ,.La. -. ,am ,w;t _.rte- r. :-e ..Y ',,,,1,,r,Tw r .. „ ;.,a ..., g zt. <br /> Job Address C+f/A ,4 L ak 7ZS 6`,1 32` ` Lot# <br /> Sub Division Parcel <br /> 1 I Bio -Hazard Waste Storage — ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct ( Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I I Hood Installation <br /> • <br /> n Emergency Generator < 30 kw I ( LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> I lnrryl l beml l IAN 1 Other <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> n <br /> Fire Alarm ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning 2 £Z' ❑ ❑ I I I l Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 1 I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ! ( Valuation of Project <br /> Fuel Tanks <br /> I Other: I <br /> Contractor " Company 6/ c'E. stERviC -E. I <br /> Signature Registered Y / N 1 Fee Current I Y / N ] <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered I Y / N_] Fee Current I Y / N <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 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 (http: / /appraiser.pascogov.com) <br />