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813-780-0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received ratsQ `" Phone Contact for Permit , ( , <br /> Owner's Name 1 ? t•rt) 1 0 3 L p <br /> V I Owner's Phone Number I <br /> ,lets Address 7 3 ) D &4tt Wu b zr1j tiRHI1V Pl 315 <br /> Fee Simple Titleholder Name Titleholder Phone Number I <br /> Fee Simple Titleholder Address I <br /> Job Address 7 3 ac!. & 4I ( ? I V b 2 G »(/1W ( 5 F( 335Y/ / Lot # <br /> Sub Division I Parcel # <br /> I, INIIINGISMINSIIMEN A <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> El Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly -ANNU ^ <br /> ry (Semi) Lai Uther / r�'��/ / <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum 7 7� I <br /> Fire Alarm ® x ❑ ❑ I I n Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ I 1 n Sprinkler System Insta 'ons <br /> Hood Suppression El ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys) 9'l / <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle Q I / ] ✓ ✓✓ <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 ( Valuation of Project <br /> Fuel Tanks <br /> Q Other I <br /> r . <br /> Contractor Company ...Ai... C <br /> Signature C ti V Registered Maaa Fee Current MK& <br /> Address C,/- IN ' 143 V 1r (' F[ License # E'IR ga3 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N J Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # 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 /> • <br />