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81;- 78o -Gu,_o City of Zephyrhills Fire �:p�J � (Fa 3- 780 -0021 <br /> Permit Application /' ` <br /> Date Received // Z —®9 Phone Contact for Permit <br /> 7s3 I _ &969 <br /> Owner's Name / / - "Yet �JCC __ t / Owner's Phone Number ) 1 t ` t r <br /> Owner's Address lef5 !r>: (/ 16/4 Z v/S 33r(12- <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> — G 2 l� ,g/1/ # 33f 7 2 ._ <br /> Lot # .�_ ,. <br /> Job Address 6O- <br /> Sub Division Parcel # <br /> ..r .. .., .._? _ ., s.., , Y : ,,:m... 'x.. 3 ..3. 6€ i<,...Z.M0 :. .,, '4A , ..,.W.. 301...,r..s„V , .,M2, . t . e n J.W. „'a - 7 <br /> 7 Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> [ 7 Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I — I Controlled Bum I1 Hood Installation <br /> I — I Emergency Generator < 30 kw Ii LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL IJ Places of Assembly- ANNUAL <br /> r y !Semi FATICI Uther <br /> Sprinkler ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I I I ( Sparklers <br /> Hood Cleaning [I ❑ ID ID I Sprinkler System Installations <br /> Hood Suppression © ❑ ❑ A I [] Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> IT Fire Pumps I I Waste Tire Storage ANNUAL <br /> I - I Fire Works <br /> n Flammable Application- ANNUAL ( I Valuation of Project <br /> [ 1 Fuel Tanks <br /> Other: I <br /> NIB xc MEas E W'Oigik 'eltga. a. aW sa , EMMICI a. aE ME <br /> Contractor ' Company >� r . / ter_c <br /> Signatur J Registered Y / N I Fee Current 1 Y / N <br /> Address I J License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N 1 Fee Current I Y / N J <br /> Address <br /> License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N . 1 Fee Current I Y / N I <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y/ N j <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N . 1 Fee Current I Y/ N I <br /> Address I I <br /> ....... - License # <br /> ..: .. <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 />