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813 -780 -0020 City ofZephyrhills Fire LI bb`I <br /> Fax -813- 780 -0021 <br /> Permit Application 1 <br /> Date Received J J Phone Contact for Permit J 12 z I 1 g 4 2 1 1'1'13 <br /> Owner's Name 1 VAS fit 14C/ 3 7 liOvs.ti Solv/7a.L/ Owner's Phone Number <br /> Owner's Address I 7/ ( CAa',ille rd . L P1 3 355 r <br /> Fee Simple Titleholder Name ( Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> - ,: = . - ..,, ... ,: .. ' s,,, -s, ...F. < g ay ,.,-a...,. ;. ....,,, ••.. - <, .. .. <br /> Job Address _ C. f3 7 /II to rrw.( V f L,v 2e // r , /6, I / 335% Lot# <br /> Sub Division <br /> Parcel # <br /> El Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> f I Comm Exhaust Kitchen Hood /Duct I Hood Installation <br /> Li Controlled Burn I—I LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Ir -- 1 r I Emergency Generator > 30 kw i l Places of Assemb!y ANNUAL <br /> © Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> IQtrlyl 175171 gm Other <br /> Sprinkler ❑ ❑ ❑ 0 Sparklers <br /> Fire Alarm ® y ❑ ❑ I J E Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ I I J Standpipes (Sprinkler Sys) <br /> Hood Suppression D ❑ ❑ ❑ I I 0 Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation = Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> n Fire Works <br /> n Flammable Application- ANNUAL I ( Valuation of Project <br /> ❑ Fuel Tanks <br /> h Other I <br /> Contractor Company A -71 1 3p ( on - re- <br /> Signature c Registered Y/ N j Fee Current ikon N 1 <br /> Address 1 35 31 1 ey,} g Rai. I License # I Er 0000 s1 1 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER Company J <br /> Signature Registered Y / N J Fee Current I Y / N I <br /> Address ( 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 52500, 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 />