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• 813-780'0020 City of Zephyrhills Fire q 6 " 1 Fax- 813- 780 -0021 Permit Application Date Received 1 I Phone Contact for Permit P72,911 1 0 2/9 I 2// I Owner's Name I Yuri (o ■r d S /77,4C. as 1 I I Owner's Phone Number I q0 I 178 6 Wei e( 2 Owner's Address I b 2-0 O Lee jeS'/ - i 8lvi. Orlc,,cYo, Pc.. Fee Simple Titleholder Name I Titleholder Phone Number I I Fee Simple Titleholder Address Job Address 1 - ' !l l� � ��G �/ YU Lot # Sub Division I Parcel # 1 Ei Bio -Hazard Waste Storage - ANNUAL I= Hazardous Material (Tier II or RQ Facility) ANNUAL E Comm Exhaust Kitchen Hood /Duct n Hood Installation L1 Controlled Burn = LP /Natural Gas - Installation Emergency Generator < 30 kw I LP/Natural Gas - ANNUAL Sale Emergency Generator> 30 kw n Places of Assembly-ANNUAL 0 Fire Protection Maintenance - ANNUAL = Recreational Bum Sprinkler ❑ ❑ ❑ ❑ El Sparklers Fire Alarm ❑ ❑ ❑ ❑ I I El Sprinkler System Installations Hood Cleaning El ❑ ❑ /// ``` 17 I I 0 Standpipes (Sprinkler Sys) Hood Suppression El CI gI El I 0 Torch Roofing/Tar Kettle In Fire Alarm Installation X. ` n Waste Tire Storage ANNUAL El Fire Pumps Fire Works n Flammable Application- ANNUAL I i/� dU I Valuation of Project n Fuel Tanks I—I Other: I I Contractor Company gfir i c - i' j e 661 v ; f . I Signature Registered I Fee Current I Y/ N Address 1 36/9 H. W. 2 " iOA ve , r ....: a, .µ: PC - Vol 6 I License # 0/9/7300o S / 98S` I ELECTRICIAN Company I Signature Registered Y/ N I Fee Current 1 Y/ N I Address I I License # I PLUMBER Company I Signature Registered Y/ N I Fee Current 1 Y/ N I Address I I License # I MECHANICAL Company I Signature Registered Y / N I Fee Current I Y/ N I Address I I License # ( I OTHER Company I 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)