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813- 780 -0020 City of Zephyrhills Fire q& 64 Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received I /t; / 3 -07 , Phone Contact for Permit 1 4-0 1 r � 1 1 4 ( 1 19 SO I <br /> Owner's Name I Ti P- e-- V-1 4 b OVY\ I Owners Phone Number I 11 11 I <br /> Owners Address I 1 54 Ct Pct-t-1 LA/ 7 - zCL - P 1-ry n- 0, u_s p,_ 3 3 j g 2 <br /> Fee Simple Titleholder Name 1 I Titleholder Phone Number I 1 1 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address I 154 0 4 AA-1- w t f5 D 7.-CPR R' hl-lS ( t'" - > 3 '5-42 I Lot# I <br /> Sub Division I I Parcel # <br /> 0 Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood/Duct I-) Hood Installation <br /> ED Controlled Bum LP/Natural Gas - Installation <br /> 0 Emergency Generator < 30 kw I LP/Natural Gas - ANNUAL Sale <br /> I Emergency Generator > 30 kw l=1 Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL n Recreational Bum <br /> L ISemrl ® Iii <br /> Sprinkler E ❑ ❑ ❑ I Sparklers <br /> Fire Alarm El ❑ • ❑ ❑ I I E] Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ I I IE Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I I 0 Torch Roofing/Tar Kettle <br /> Igl Fire Alarm Installation ri Waste Tire Storage ANNUAL <br /> 0 Fire Pumps <br /> 0 Fire Works <br /> Flammable Application- ANNUAL ( `7.-`4 'S 0 • W I Valuation of Project <br /> 0 Fuel Tanks <br /> 0 Other: 1 <br /> Contractor ) Company C hlot.(SG_Cl.(Rt1M64si 15 tl-ig <br /> Signature i Registered Er N I Fee Current I Y / N I <br /> Address I 5l "1 ►.( W1l / t 0fu-A 00 ( F- 3 -&'3 I License # I F i--ZV0 Uo, ■ 6 I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address ( License # I 1 <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # 1 <br /> MECHANICAL Company 1 <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # 1 <br /> OTHER Company 1 <br /> Signature Registered Y/ N I Fee Current I 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 />