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813 -780 -0020 City of Zephyrhills'Fire Fax- 813-780 -0021 <br /> Permit Application ' <br /> late Received FRE ! Oir • - Phone Contact for Permit C M111111 I►RE1 S J gep <br /> )wners Name E-i (2.5 (.X1 r ( : la rt 1'l ■.l eG k Owner's Phone Number RIM I1 a k 1 /C. 9 1 <br /> )wnees Address u V 4 0 , c-&-A-11. Si 2. et Hri, I t 5 F 1 3 3 5/-7 :ee Simple Titleholder Name ( Titleholder Phone Number I I <br /> :ee Simple Titleholder Address I <br /> Job Address ( 4 ,� y () ` a 4 4 \ . . S 4 - • 2 (2611 i r f i l l , P1 3 3 5 y a' Lot # <br /> Sub Division Parcel # <br /> El Bb- Hazard Waste Storage - ANNUAL ED Fumigation Tent <br /> El Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL, . � j (� <br /> E <br /> Burn n Hood Installation ,r /� _ <br /> i � ` r <br /> n Emergency Generator < 30 kw LP /Natural Gas - Installation "./ L1L. <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sal <br /> • <br /> Fire Protection Maintenance - ANNUAL Places of Assembly -ANNU <br /> �; emr tim _ _. ,/ <br /> r ems„ u o <br /> Sprinkler n ❑ ❑ ❑ j n Recreational Bum <br /> Fire Alarm ❑ ❑ XI 1 El Sparklers ..0' <br /> i <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ ❑ I } ED Standpipes (Sprinkler Sys) g4, <br /> Q Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> IN <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> • <br /> Fire Works <br /> Flammable Appiicatlon- ANNUAL 1 I Valuation of Project <br /> Fuel Tanks <br /> n Other. 1 <br /> Contractor ' Regist Company Q /7� n /e'e�ZN A// �, S i <br /> Signature Registered MEN Fee Current Y / N <br /> Address 11379/9 tS� d6•u ,PA -7-4— !J. teir. a 4. A Fe.. License# 115 P - 6 ©C) /1) y 6 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I 1 License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Currant Y / N <br /> ' <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered , Y / N I Fee Current I Y / N j <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I <br /> License .. _ _ .._ _ _ .. ......... 1 <br /> # <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 52500, a Notice of Commencement Is required (Mechanical work over 55000) <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 />