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813-780-0020 City ofZephyrhills Fire. _ _ �` Fax - 813 -780 -0021 <br /> r Permit Application <br /> Date Received 5-- ,T—? .Phone I69 - .m,_r r...... <br /> ne Contact for Permit a 3 I ' 7 > C C) <br /> Owner Name f%VI' /I EX / Lk C7 /r- -U(Jf- 2,,J E Owner's Phone Number 8/3 "y . CC q <br /> Owner's Address 36a et /Mfrepv- L-I. --- PA FL- r/e <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address Ixs... <br /> _.:.: � •� d ° .... c � _... � ....� . - - <br /> Job Address 20 .5--c.....) 4A .. ✓ cY Lot <br /> Sub Division 1 <br /> Parcel <br /> Bio- Hazard Waste Storage -.ANNUAL El Fumigation Tent <br /> I-I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I Hood Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> i --- 1 Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> ry 'bemll IVther I <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 I ] Sparklers <br /> Hood Cleaning 71 ❑ ❑ ❑ 1 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ J 1 Standpipes (Sprinkler Sys) <br /> I Fire Alami Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps El Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL /i .9C-=e--? -I Valuation of Project , It <br /> I Fuel Tanks <br /> 71 Other: I <br /> Contractor Company LA-P5c C) • --- 0 Li57 - / 2 t ■-S <br /> Signature ` Registered a) N Fee Current Y / N <br /> Address I 01 4cg5- E /4-63A -7"t-ci AO it , 7'A PH- License# $3" e.5& ii2Oe:" aCx:: <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 I Y / N I <br /> Address I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N 1 <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address License # I I <br /> mates .. ._,. „�,.a.a ..: . =., m:,E .. ruarmwa:ror .;rnm ,..... - ,._,..._ ,,..,_..... ..:. ., ,...,r.. ase:::'S�> .:.?z,�mo...a'- -r,.._ - ,...:. .. _.., .. ,.. ... +,.�.ro..�•;..a,x.csr -v_.. <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 />