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813-780 -0020 ' City of Zephyrhills Fire 13 Fax-813-780-0021 <br /> Permit Application <br /> Date Received 1 r —72 ' 27 I Phone Contact for Permit 1 741 Ha I to !� <br /> Owner's Name 1 li�•r J Co 51,2 e—n 6t4 1 Owner's Phone Number 13.7 Z I 1 763 I n1 <br /> Owner's Address 53 ''l 4 / 9 Q 'd S ' 2E'p `4� /f� <br /> , i -g- 335 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> LL I , c �i J <br /> S3Y Job Address % 9 f� I • pAy ��, • t" .533-1,Z Lot # <br /> Sub Division Parcel # <br /> El Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> I. <br /> n Controlled Burn a LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> i 0 , <br /> a Emergency Generator > 30 kw = Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL = Recreational Burn / /e i►/� nS <br /> ry ISemil UM Other "' <br /> lo y <br /> Sprinkler CI ❑ ❑ ❑ 0 Sparklers `/ <br /> Fire Alarm CI ❑ ❑ ❑ l I n Sprinkler System Installations <br /> Hood Cleaning CI ❑ ❑ ❑ I 1 0 Standpipes (Sprinkler Sys) <br /> 1-11 Hood Suppression ❑ 11 ❑ I I n Torch Roofing /Tar Kettle <br /> Fire Alarm Installation = Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> LJ Fire Works <br /> n Flammable Application- ANNUAL 1 / sew - 6 0 ( Valuation of Project <br /> El Fuel Tanks 1 <br /> Q Other: AbairTM.s TD Hite J�sTCt,... <br /> Contractor Company 73 a SC . 6 ,t I <br /> Signature � Registered Y / N I Fee Current I Y/ N <br /> Address ( 7 I License # ¢-rGGC Oyvt/ <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address ( I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y / N . 1 Fee Current I Y / N <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 />