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813a80-0020 City of Zephyrhills Fire . 1959 q Fax- 813 -780 -0021 <br /> Permit Application <br /> M1 <br /> Date Received j Phone Contact for Permit <br /> Owner's Name V F,elt,c ar)r9p s Owner's Phone Number I 7s: i 3S irs1 <br /> Owner's Address 3) C-01 a t v b <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address (/ �f � �J' ( ) I 1 8'i 0c Lot# <br /> Sub Division Parcel # <br /> ,,.. :, v . _ Z:,'....> M ,., -. :.:..WMU M:∎; :..a..i.f vim °.., IM . ,.>. :; ..._w..,. .€. .M3. , ; .y. ... : :.: e A. ......k -vs, iN ,.. , <br /> F Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I—I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> IQtrlyl !semi' [ATE tither <br /> Sprinkler n ❑ ❑ ❑ n Recrea al Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ ( I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> I Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> I I Fuel Tanks <br /> n Other: I I <br /> ...... ,zt...,. ...., . , ..�....� i ... _.,a. 5.. , ,.., . :.... ..,,. . ..rte .. .. _ . . . _ .. ..... <br /> Contractor Mgr Company � _ 1[Ac C� I <br /> Signature Registered Y / N I Fee Current Y/ N j <br /> Address I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y / N j Fee Current I Y / N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N J Fee Current I Y / N j <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N Fee Current Y/ N I <br /> Address I 1 License # I I <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 />