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813-780-0029 City of Zephyrhills - Fire. { _ ' C j (€ c Z Fax-813-780 -0021 <br /> _ Permit Application - <br /> )ate Received Q I ` Phone Contact for Permit 357, 15G 7 1 5 <br /> 941 <br /> )wner's Name I m 1 C l p -'Q.,1 G. Mn m kt S Owner's Phone Number Y/3 7f j ?// <br /> )wner's Address 9 O 3 1 G { I 13 1 (> a 2 'e- ti 1 r k, 1 (5 f � 3 -1 �" <br /> :ee Simple Titleholder Name Titleholder Phone Number I I <br /> :ee Simple Titleholder Address I <br /> __ -- -? '- rzg='i' u. "a ."-`+a=r' rd: u ! :gan ,:,. -_.:� x ,- t. ...,.. ; rte .} 'l" _.z...a, ' - .i,Li �.. . ..._. <br /> Job Address V ".._ _ -.- - • _ le J•. a 1 fI 335 Lot # <br /> Sub Division 1 0.=,1 o, e h r 'its Parcel # ,,7 2/ 01 y��M � <br /> W�� <br /> n Bio-Hazard Waste Storage - ANNUAL El Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct I. Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I — I Controlled Burn 1 1 Hood Installation <br /> n Emergency Generator < 30 kw 71 LP /Natural Gas - Installation <br /> 1 E rgency Generator> 30 kw 1 1 LP /Natural Gas - ANNUAL Sale <br /> !!! Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> L"it3F1 lSemil FrT1 Other <br /> Sprinkler ❑ ❑ ❑ ❑ r Recreational Bum <br /> Fire Alarm [1S ❑ VI I Ti Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ 1 1 1 Sprinkler System Installations <br /> Hood Suppression 0 D 0 l j I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation 1 Torch Roofing/Tar Kettle <br /> I 1 Fire Pumps I Waste Tire Storage ANNUAL <br /> Fire Works • <br /> 1 Flammable Application- ANNUAL i 1 Valuation of Project <br /> I i Fuel Tanks <br /> 17 Other: I <br /> role. ^ - : ;, -; a ''fEa ='rggxai?' , 0 „.. ....� ',,r. r.,0. ;.Mr _ :0...0. ..:s- : _ ,- 3i.G to s X.l 4Eir';rAgY,ie- .A'0::mk— �piksx nuelS asoz .s <br /> s - h - -. <br /> Contractor Company S'Q�G iC� / 4-c..4-44,.... C 5i51-0.--1 <br /> Signature .. Lc., Registered l( / N Fee Current I Y / N <br /> Address 1 - A CC f f e Z P ? 1 License # 1 F/ vl)C) /a/62 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current 1 Y/ N 1 <br /> Address ( License # 1 I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current Y/ N 1 <br /> Address 1 1 License # 1 <br /> MECHANICAL Company k <br /> Signature - i Registered Y / N 1 Fee Current 1 Y / N 1 <br /> Address 1 I License # I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y / N 1 <br /> Address 1 <br /> License # 1 <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 />