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(/ ? `' t <br /> t)13- 780 -0020 City of Zephyrhills Fire r Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received , . 0 1 Phone Contact for Permit 1 72 14 2 1 I I g q 3 <br /> Owner's Name 1 8 O uS r /v S 0 Ai . 1 O f0 IL 5 er's Phone Number I V 3 g_33 93 <br /> Owner's Address 1 �� t/ j <br /> 4 7 i c 1 Ir R. a e_ d Lit -6_ 3 3556 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 6 y 3 7 A e riICA / V / <br /> L il-/ Lot # <br /> 0 Z0 2i_ C -ft - C -46, <br /> Sub Division � <br /> Parcel # <br /> ( I Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> J ] Comm Exhaust Kitchen Hood /Duct I] Hood Installation <br /> I I Controlled Burn I} LP /Natural Gas - Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I - I Emergency Generator> 30 kw 17 Places of Assembly-ANNUAL <br /> I XI Fire Protection Maintenance - ANNUAL Il Recreational Burn <br /> IQtrlyj ISemiI (AFTl Other <br /> Sprinkler 0 ❑ ���,,,0 ❑ n Sparklers <br /> ,et <br /> Fire Alarm © ❑ El 1 I 1 Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ,❑\ ❑ 1 I I 1 Standpipes (Sprinkler Sys) <br /> Hood Suppression 1—I ❑ ❑ ❑ I I I J Torch Roofing/Tar Kettle <br /> 7 Fire Alarm Installation I Waste Tire Storage ANNUAL <br /> I Fire Pumps <br /> I — I Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> I'7 Fuel Tanks <br /> n Other: 1 <br /> Contractor Company A T , 4. ( So (l. - 'on . "c... I <br /> Signature ` Registered Y / N J Fee Current I Y / N I <br /> Address 13 5 31 VI e- •k Rd. I License # I E V OOOO'N 44 1 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address 1 <br /> I License # <br /> PLUMBER Company I <br /> Signature Registered Y / N j Fee Current I Y / N 1 <br /> Address I <br /> I License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N j Fee Current I Y / N 1 <br /> Address I <br /> I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # <br /> Directions: <br /> Fit 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 />