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813- 780 -0020 City of Zephyrhills Fire 4 q 55 ((,, Fax- 813- 780 -0021 Permit Application Date Received !RIM 0 Phone Contact for Permit I} 21- 111 z 1 1 1 q q 3 Owner's Name M 6N " L �., r I Owner's Phone Number I • Owner's Address ?•a y / pr. 2 { /� 4 r l/� `/- ??5-11.: ! Fee Simple Titleholder Name I I I I I I I I Titleholder Phone Number Fee Simple Titleholder Address I . Job Address e f rPr. 2f �4 11 / / ?3f9)i i Sub Division I i ' Parcel # I I Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL n Comm Exhaust Kitchen Hood /Duct n Hood Installation n Controlled Burn In LP /Natural Gas - Installation n Emergency Generator < 30 kw I I LP /Natural Gas- ANNUAL Sale 1 1 Emergency Generator > 30 kw I I Places of Assembly- ANNUAL r KI Fire Protection Maintenance - ANNUAL r Recreational Burn IQtrlyl ISemil Fri, Other Sprinkler n ❑ ❑ ❑ Sparklers Fire Alarm ❑ ❑ ❑ 1 ( I I Sprinkler System Installations I I Hood Cleaning ❑ ❑ ❑ I 1 I I Standpipes (Sprinkler Sys) Hood Suppression I ❑ ❑ ❑ I 1 1 Torch Roofing /Tar Kettle n Fire Alarm Installation I Waste Tire Storage ANNUAL I I Fire Pumps El Fire Works F Flammable Application- ANNUAL I I r Valuation of Project Fuel Tanks Fl Other: I 1 Contractor I Company - Signature o Sn �ti 44 0 Registered Y/ N 1 Fee Current ? Y/ N I Address ( 3531 K ,54-a „E, I License# ( 42353go0o la I ELECTRICIAN I I Company Signature Registered Y/ N I Fee Current I Y/ N I Address I 1 License # I PLUMBER I Company gnature Registered Y/ N I Fee Current I Y / N I Address I I License # MECHANICAL' I Company I Signature Registered Y/ N j Fee Current I Y/ N I Address I I License # OTHER I Company Signature Registered ( Y/ N I Fee Current I Y / N I Address I I License # I I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)