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813 -780 -0020 City of Zephyrhills Fire loq (� Fax -813- 780 -0021 <br /> Permit Application q (� <br /> Date Received ®,rl� O Phone Contact for Permit F <br /> Owner's Name Cr l; is �,< Z 2_'- 1 Owner's Phone Number I '3 3 I I7c6o I I /0t` <br /> Oner's Address b eh y &w// 0/1/1 335-4z_ 7 I <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address ! <br /> ;rte s . , F .', ,lx ells i t gfiMgr V , , „w 4 K: ,, :. t ; , ,°> MI i . OMMV « 10,SIaa, ' £ IL m. arMIN R , <br /> Job Address 693 (-7 a // /5/v/ 335 2 Lot* <br /> Sub Division Parcel # <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> gn Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Iutrlyl (Semi) WI !Other 1 1}4 ( <br /> Sprinkler ❑ ❑ ❑ I Recreational Bum 7j � Y, <br /> Fire Alarm no ❑ ❑ i I n Sparklers <br /> IAA <br /> C <br /> Hood Cleaning ❑ ❑ ❑ 1 1 1 Sprinkler System Installations <br /> Hood Suppression m ❑ ❑ g I 1 <br /> Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> FR Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 17 I I 5 ( Valuation of Project <br /> Fuel Tanks <br /> I Other: I <br /> Contractor i rc / 9 iv "etc_ I <br /> t - = �i� <br /> Company /' <br /> Signature ___----7-- _.d`�� Registered Y / N I Current I Y / N <br /> Address o ( �,, k esse Ca v y d� License* <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current 1 Y/ N I <br /> Address I I License # I <br /> PLUMBER I I Company t I <br /> Signature <br /> Registered Y/ N j Fee Current I Y / N j <br /> Address I I License # ! I <br /> MECHANICAL! I Company I <br /> Signature I I <br /> Registered Y _I / N Fee Current 1 Y / N <br /> Address I ( License # I <br /> OTHER I ( Company <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address <br /> License # <br /> Directions:2 . ,:: _«; .a,..• w r ,. �a ,.. >:w «. �� : •w . <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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />