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813-780 -0020 City of.Zephyrhills Fire. Fax - 813 -7so -ooze <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> D L - <br /> Owners Name ,.. <br /> 6.4-4 f_ I r / Own � er's Phone Number <br /> Owner's Address ?30 64-1,1_ R l-V eC Z e iv r L t (l h / f - - 35 !/ 1 <br /> Z <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address b E°3 0 6 4 - t - c . 6 .. VX 2c thy 1 4 ((1' ( 33 5.4 2— Lot* <br /> Sub Division Parcel # <br /> Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL • n Places of Assembly- ANNUAL <br /> I tdtny 1 !berm I Mill Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning ® ❑ x ❑ I I I Sprinkler System Installations <br /> Hood Suppression Z ❑ „le ❑ I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle , <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ` ( Valuation of Project <br /> n Fuel Tanks <br /> in Other: I <br /> a y <br /> Contractor nature <br /> Contractor Company �/1- i /-r v i M e n'- <br /> Si ����I�- Registered Y / 1 Fee Current I Y / N I ....ti.C, <br /> Address , __ J oZ i - t ' L I . M g License* 1 859 6 3 C O Oo' l 99 o <br /> ELECTRICIA A Company <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address <br /> I License* <br /> PLUMBER . <br /> Si Registered Y/ N 1 Fee Current I Y/ N <br /> Address I I L # I - <br /> License <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y / N <br /> Address I I License* <br /> OTHER , <br /> Company <br /> Signature Registered Y / N I Fee Current I Y/ N <br /> Address <br /> License # <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 />