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813-780-0020 <br /> City of.Zephyrhills Fire e35 Fax -813 -780 -0021 <br /> Permit Application <br /> 1 q —s - - '8 1 Phone ..:., r...n .w. <br /> hone Contactfor Permit �! � �f 7lX5 <br /> Date Received <br /> CAF ] ma � n; ,., . ... ._ �. .. <br /> x c:t d :G9.. t <br /> /' /i ce <br /> ..�. n I AC/ �. /K. (. of c 1 Owner's Phone Number 03 Q 3 3 ?- <br /> Owwnnerr''s s Name <br /> Owner's Address 1 1 <br /> 1 Titleholder Phone Number 1 <br /> Fee Simple Titleholder Name <br /> Fee Simple Address , en s ..... I . <br /> +.�..+o' u�"�'v "'�'�rt °a�ax3�s;��'2 . '�y i„*,>:�cv�a'1�� � ^ . : =.a-y- u. ., t;� � � w ...,n � .;- <br /> �., ._ � t# (� �e L <br /> Job Address �� /� <br /> Sub Division j 1 Parcel # 1 <br /> c . ^ <br /> I 1 Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Controlled Burn n Hood Installation <br /> Emergency Generator < 30 kw I 1 LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw <br /> LP /Natural Gas - ANNUAL Sale <br /> 1 1 Fire Protection Maintenance - ANNUAL I 1 Places of Assembly- ANNUAL <br /> ptnyl ISemi rA711 tither <br /> Sprinkler n 12 12 12 f I I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I . 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps Ti Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> Flammable Application - ANNUAL J /4:7C:7 Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor 7� IA. Registered 3("7 iv OL t R-1 GI <br /> • <br /> Signature <br /> RegisteredI Fee Current I Y / N <br /> _ <br /> Address 9045" E -r L}0/ -/"rte fl� , T4 /"` p� I License # SS/ 83g ��° `'a 5 I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered _ Y / N I Fee Current Y / N <br /> Address I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y/ N <br /> Address I License # <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I 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 />