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813-780-0020 City of Zephyrhills Fire 1 'U Fax -813- 780 -0021 <br /> Permit Application 7 fo , _ <br /> Date Received //— 5 Phone Contact for Permit <br /> Owner's Name t7 ,/ /- __.. if i. 1 J 4 e / Owner's Phone Number <br /> — <br /> Owners Address 4' 4'/v 59` C f <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address V (e 0/7/0 f g-7-# . 0 Lot <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> n Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 1C.ttrlyl !bemii Frill Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ 0 I 1 I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I Standpipes (Sprinkler Sys) <br /> IT Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I I Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I I Flammable Application- ANNUAL I Valuation of Project <br /> n Fuel Tanks <br /> I—I ther: I I <br /> .a ; .. 24: .... ff ,..,"T ,., S AF.;ae`.,,s1=sa axtQ4 ' d.e, ., :... ; k : te. LO. IL:E .. ».....,s.? ... .Y2 . .M .3.... K rs ..J......, <br /> Contractor Company /S6 A/ 4i I <br /> Signature I ren <br /> ( <br /> Registered Y N I Fee urt I Y / N j <br /> Address I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N <br /> Address I <br /> 1 License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N j Fee Current I Y / N I <br /> Address I 1 License # I <br /> OTHER Company I <br /> Signature Registered Y / N 1 Fee Current 1 Y/ N 1 <br /> Address I <br /> 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 />