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813 -780 -0020 City of Zephyrhills Fire ,14616q6 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received <br /> 1 Phone Contact for Permit 112 z I q q 2 I► g q 3 <br /> Owner's Name P 0 P , , J O LLG Phone Number 1571 I 1 3 J % ? , <br /> Owner's Address 15 2V COAe,,jv l6VN Ter,. q, P i q ,i <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> Job Address 4 f3 neekA' U) 'e.v Goti,,e Z I r /s 335V Lot# I <br /> Sub Division Parcel # '/jr / I /t <br /> J Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I—I Comm Exhaust Kitchen Hood /Duct I I Hood Installation <br /> (i Controlled Burn I LP /Natural Gas - Installation <br /> I 1 Emergency Generator < 30 kw I 1 LP /Natural Gas - ANNUAL Sale <br /> IJ Emergency Generator > 30 kw I I Places of Assembly- ANNUAL <br /> F -- >i Fire Protection Maintenance - ANNUAL I I Recreational Burn <br /> IQtrlyl'Semi i""'1 Other <br /> Sprinkler 0 ❑ ❑ ❑ I I Sparklers <br /> Fire Alarm � ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I I 1 I Torch Roofing/Tar Kettle <br /> 7 Fire Alarm Installation I] Waste Tire Storage ANNUAL <br /> 7 Fire Pumps <br /> 7 Fire Works <br /> ' Flammable Application- ANNUAL r 1 Valuation of Project <br /> � ,.�� ' <br /> Fuel Tanks <br /> n Other: I <br /> Contractor Company nG <br /> A T -- 1 , (u41.Or1. <br /> Signature c Registered I Y/ N J Fee Current I Y / N 1 <br /> Address I 35 31 1 J ane p,c1, I E.F0000 4 1 I <br /> `( 1 License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address I I License # I <br /> PLUMBER 1 Company 1 I <br /> Signature 1 Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N ] Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <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 />