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813 - 780 -0020 City of.Zephyrhills "Fire -kRq Z 6 Fax - 813- 780 -0021 <br /> ,p Permit Application <br /> Date Received - FaK 12. 23 05 Ph Permit Contact for Pe t- <br /> ® _ <br /> Owner's Name 6 A SI a / 7 . ,L - l A q�sll <br /> LO IVR V? /9Y Owners Phone Number O 4' J 3s J <br /> Owner's Address 70 Bar - 9 7 3 8 - 7 - 4 - / 1 T /9 - FL- 33674E- <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> , ,,f,,.a .217 F — '' t ,0-- =w-,,, , , - ae- , - � . . . . -: ... --. & „,:ro. - :... . x':,, .'c ),•:;#, ri, :,- :t3;€a ,.' - .n.ft. ; <br /> Job Address Wy /A/O 1 ' / 22 4 SVSQ 7 Si-1/1), Lot# <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum [ I Hood Installation <br /> I - I Emergency Generator < 30 kw - n LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> IUtriyl IbemiI Other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning 17 Er ❑ I I I I Sprinkler System Installations <br /> Hood Suppression D ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 1 Valuation of Project <br /> Fuel Tanks <br /> I Other: I <br /> iF. Myx; ,. --rc'_ r: ti:- , .v.. .41' +.n ':..:eM. , .F .ntf'?.... s ::.... A .:>s,- . .b ... .... .«!z ,,, �,.A .. _..Cr.E hc... BF.e - ,.,_ t- SS3.�.. +r+ .r.P.✓ .,. .... . _..... .. .. :s ., .. <br /> Contractor `�fZ"( Company Z /AM U 'i 10 ffs <br /> Signature _ Registered L —P- / N I Fee Current J Y / N <br /> Address I I License* ( I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N J <br /> Address I I License # I I <br /> PLUMBER I Company I <br /> Signature Registered Y / N „I Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N j Fee Current I Y / N j <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current 1 Y / N I <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 />