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813 - 780 -0720 City of.ZephyrhillsFire. 401 7 ,3 Fax - 813 -780 -0021 <br /> Permit Application l/ <br /> Date Received Phone Contact for Permit MEM 1 4 1 5Zl <br /> Owner's Name , croc. r(la kuk ZoNa.iff In(. Owner's Phone Number 1 , <br /> Owner's Address 5 %\3) r(\OIkR.4 y JQy{ L..P filtirk; L'S 1" Z <br /> Fee Simple Titleholder Name 1 Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> Z 2 <br /> Job Address 381 5 h�d r kl4 I JCt YL f. L j i, n'k / l F/ J 2. Lot <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent . <br /> n Comm Exhaust Kitchen Hood /Duct ( I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 1 1 Emergency Generator> 30 kw 1 ] LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL 1 Places of Assembly- ANNUAL <br /> ItAtny1 16emi1 177 Other <br /> Sprinkler n ❑ ❑ ❑ ( I Recreational Bum <br /> Fire Alarm ■ ❑ ❑ • ( ( ( I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 ( Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ ( I ( Standpipes (Sprinkler Sys) <br /> Fire Alami Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> n Flammable Application- ANNUAL ) Valuation of Project <br /> 1 I Fuel Tanks <br /> n Oth; 1 <br /> Contractor ' Company rD,11Li �r[ ..c ,, <br /> Signature , I <br /> AW. -,�, It Registered W/ N Fee Current / N <br /> Address I r I License # R E F p-7:5 <br /> ELECTRICIAN • Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current 1 Y / N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature . Registered Y / N . 1 Fee Current 1 Y / N I <br /> Address I License # <br /> OTHER Company <br /> Signature Registered Y / N j Fee Current ' Y / N <br /> Address License # �_ -. _...... .. <br /> Directions: <br /> Fill out application completely. • <br /> • <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 (httpJ /appraiser.pascogov.com) <br />