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813 -780 -0020 City ofZephyrhillsFire. Fax - 813-780 -0021 <br /> Permit Application <br /> /fi <br /> . <br /> Date Received / I 0 01 - Phone Contact for Permit 2l 3 <br /> ,� .— ..*�;., <br /> s._.,�.. 1 g 3S7' <br /> _ <br /> Owner's Name 471 I '524° 1<U�� - Owners Phone Number R1 S• % 3,� <br /> Owner's Address TO BO 1738 " 7 //� 3367 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ,xw— .'yw?+�bk:. �:.�. aRAtiE . %fm'..`'n..ad'Yb.+.Ki4;v" :L'.R�£S&.?4ff•N.S+s.... - a:.r:^'9!kK *:%rkK�4 .; �`... �. . . .e. .+te'J. .%.+.-a,..S i-:.N,b <s ".(•R`�:J'. .--+Y !'.a... ...... _ ... j ."w &� 'S:a 'c? df.. <br /> /� j � , / <br /> Job Address po /V 77.9A/D4 37' /5 zE/L441 Z L� Lot# <br /> Sub Division Parcel # <br /> ; . � - ,+�.. '-�_ [S�.ae�u'.. �'1�• =� ,N ,a ,x �.,; .=� :aaT.rm��'•a.�:..v r.=.a a.._. .. <br /> n Bio-Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> l(,ttrlyl [berm! Uther <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I Sparklers <br /> 1 <br /> Hood Cleaning ,y� ❑ ❑ I <br /> I I ( Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> I Fuel Tanks <br /> Other <br /> Contractor Company v /G -SE , a6 : 1Z /X <br /> Signature & Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y/ N j <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y / N I <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 />