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813 - 780 -0020 City of Zephyrhills Fire Irq l <br /> Fax - 813 - 780 -0021 <br /> Permit Application <br /> Date Received . f <br /> 1 • <br /> Phone Contact for Permit 114 it I I t . 1 z I I 1 g q I <br /> Owner's Name ^ ,�� <br /> �� � � B f ~ >l� Owner's Phone Number ' <br /> s 1,// Ze A dt/ /s P. 35 I 1 <br /> Owner's Address I -3 y �a �C t � // / � �� i <br /> Fee Simple Titleholder Name • l <br /> Titleholder Phone Number I I I I I <br /> Fee Simple Titleholder Address I <br /> Job Address / w y Ze. 4 /A I/5 r/. Lot # I i <br /> Sub Division <br /> Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL <br /> n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Comm Exhaust Kitchen Hood /Duct <br /> I , Hood Installation <br /> Controlled Burn = LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator> 30 kw I I <br /> Places of Assembly- ANNUAL <br /> IX 1 Fire Protection Maintenance - ANNUAL l� �1 <br /> (Qtrlyl 1SemiI I 1 Other f ' Recreational Burn <br /> Sprinkler © ❑ ❑ �{ ae I I I <br /> f'� 1 Sparklers <br /> Fire Alarm n ❑ ❑ ❑ I I I I <br /> Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ I I I I Torch Roofing /Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> I I Fire Pumps <br /> n Fire Works <br /> I I Flammable Application- ANNUAL I <br /> r n Valuation of Project <br /> Fuel Tanks <br /> El Other: 1 <br /> Contractor <br /> Signature !‘ Company A -- - 1 5o 644 o I av <br /> I Registered Y / N Fee Current Y/ N <br /> Address 3531 Vlat54-one, I <br /> License # I q2 3531%000 12 oo z I <br /> ELECTRICIAN' I <br /> Company I <br /> Signature <br /> Registered Y/ N I Fee Current 1 Y / N I <br /> Address I <br /> 1 License # I <br /> PLUMBER I I <br /> Company <br /> Signature <br /> Registered Y / N I Fee Current 1 Y / N I <br /> Address I <br /> License # <br /> MECHANICAL' I <br /> Company <br /> Signature <br /> Registered Y / N 1 Fee Current I Y / N I <br /> Address I I <br /> License # <br /> OTHER I <br /> Signature <br /> Company I <br /> Registered Y/ N J Fee Current I Y/ N <br /> Address I I <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 />