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813 - 780 -0020 City of.Zephyrhills Fire. rax -o t -i ov i • <br /> Permit Application _. . _.. <br /> Date Received <br /> Phone Contact for Pemilt <br /> iNYM4ik <br /> Owner's Name 1 1 ,n 6 1C -4-c_ L y iL I Owner's Phone Number 1 l N 1 VA I $q <br /> Owner's Address 3ti31 Ml 5 Q UIQ7a . <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 36 l mf -t (...rr ' L5It)A,e�s Da-. Lot# <br /> Sub Division G.1 f`( 1 f Z(.='P ki 14- 4( -lC.C.S Parcel # 102. -- jam. 44-0010 • 0"5900 •t <br /> El Bio -Hazard Waste Storage - ANNUAL h Fumigation Tent <br /> Ej Comm Exhaust Kitchen Hood/Duct FT Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum h Hood Installation <br /> ED Emergency Generator < 30 kw h LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I LP/Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL r Places of Assembly- ANNUAL <br /> FMil WEI (A Uther <br /> Sprinkler IN ❑ ❑ I Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I I El Sparklers <br /> Hood Cleaning ❑ ❑ ❑ . I 1 n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ 1 I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation j ] Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> dIS Z s - - 00 ) Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor 3(yLf`• T • _ ^` "' r i g ' <br /> Company (1�0lAY% F .� 5 <br /> l ft.(�Z.i!'1i1CL-t:7a•S . ) rlc • ( <br /> Signature / J Registered (P/N 1 Fee Current I / N <br /> Address IX. -519 l 1.1 . 10 - f PP- , pt .. ,1 45 ( License # I e,V•e, z o l i co6 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N J <br /> Address ( " I License # <br /> PLUMBER •; -. i Company <br /> P Y <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N J <br /> Address I 1 License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N l <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 />