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�r� <br /> .,813- 780 -0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> Permit Application <br /> Date Received I ( ) 9- 0 9 ( Phone Contact for Permit 19 V/ 1 -lei 2 j <br /> Owner's Name I V /Of ( H ✓ .. fZ& f I Owner's Phone Number lg 3 7 ' 1 o(-41/ I <br /> Owner's Address 1 470 9' 6"!f9-/1 8/.1)'• <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address V ni 1 f? I V 0 Lot # <br /> Sub Division Parcel # <br /> Q 2 — ). ( -a) x,6 -02sco <br /> Li Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El C - omm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n C - ontrolled Burn n LP /Natural Gas - Installation <br /> n E - mergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> n Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> 1Qtrlyl 'Semi I IAni I Other <br /> Sprinkler 0 ❑ ❑ ❑ 1 1 Sparklers <br /> Fire Alarm n ❑ ❑ ❑ ( I 1 11 Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys) <br /> Hood Suppression Rf ❑ X ❑ 1 1 n Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> pi Fire Works <br /> Flammable Application- ANNUAL I ?Qd , 0 U I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I I <br /> Contractor ,` t • Company ( / � %t - R 1 r - I rci t -i w <br /> Ir <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address , • -D , f (nit ) r l/jV ' 336 - License # I <br /> ELECTRICIAN 1 Company 1 <br /> Signature Registered Y / N I Fee Current I Y/ N 1 <br /> Address ( I License # I I <br /> PLUMBER Company 1 <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company 1 <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> OTHER Company 1 <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address 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 />