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813 - 780 -0020 City of Zephyrhills Fire IP l '7 3 I <br /> Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received f <br /> Phone Contact for Permit I ,ir , (9.t..) ,'L I II g q 3 <br /> Owner's Name � P . l <br /> Ped : G / r/ ( 16f I Owner's Phone Number I 1 1 1 <br /> Owner's Address 6 7 n ■ a I / 7 (�� / //S PA 3 3s y � <br /> Fee Simple Titleholder Name I `I• I 1 I I I <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> .lob Address Y X # F ,t f <br /> / I (/ • lS I / 33sy,1 Lot # <br /> Sub Division I <br /> Parcel # <br /> I I Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct El Hood Installation <br /> n Controlled Burn = LP /Natural Gas - Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> 1 I Emergency Generator > 30 kw I I Places of Assembly- ANNUAL <br /> (X j Fire Protection Maintenance - ANNUAL II Recreational Bum <br /> (Qtrlyl (Semi Fil 'Other I <br /> Sprinkler Ix 1 El ID <br /> Fire Alarm no ID ❑ I I Sprinkler System Installations <br /> Hood Cleaning n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ 1 1 1 I Torch Roofing /Tar Kettle <br /> I 1 Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> 1 1 Fire Pumps <br /> 1 I Fire Works <br /> I I Flammable Application- ANNUAL <br /> 1 <br /> 7 Valuation of Project <br /> Fuel Tanks <br /> In Other: I <br /> Contractor .. <br /> Company A T 1 50 to 4-i n I <br /> ,�' <br /> Signature }I <br /> Registered Y / N Fee Current Y / N <br /> Andress 1 3531 Illet L icense # <br /> I g235.3go Ia00 I <br /> ELECTRICIAN <br /> Company <br /> Signature I <br /> Registered Y / N I Fee Current I Y / N <br /> Address I I <br /> I License # I <br /> PLUMBER I I <br /> Company <br /> Signature <br /> Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> I License # <br /> MECHANICAL( I <br /> Company <br /> Signature <br /> Registered Y/ N I Fee Current I Y/ N I <br /> Address I I <br /> I License # I <br /> OTHER <br /> Company I <br /> Signature i <br /> Registered Y / N 1 Fee Current I Y! N <br /> Address <br /> 1 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 />