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813-780-0020 City of Zephyrhills Fire G I„ Fax -813- 780 -0021 <br /> Permit Application -1 G4" <br /> Date Received /d ©Q Phone Contact for Permit I �� 3 b a 3 I Q/ <br /> w.. -��y a,�-...zn..�sr.�n.nm,..,.. _-- .;,,-.�� .. _„ _. : � ,..,.... , .a�.aa:: :- .,^wwa�:^- -✓ -��.. � <br /> Owner's Name .111•1' p l -ex Etr th n ell Owner's Phone Number <br /> Owner's Address 14701 Oa k Fa S 1 t'd * To n1p , C-L _ 1 5-5 to / d <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> -- ,.. .o., , .... - ,,,. ...,,' ,,:}, tr_' ..1,,i£ '- ".x -; :r• +x : Z, t s '- FZ,, ,,,: d 4a±.° ,, fzYr; ?' ,, 7 ',... , a+i ? " .4 144 ;41 zos . C "` % ....Xa4,,,„ :. .uta4 * -, ' : 'gi ' <br /> Job Address 71D 3 Ex 81 vd Ze p h r 1� 11 \ I f 2 - . Z33 / / Lot# <br /> Sub Division f r Parcel # <br /> :?.^':,;^ a,.; u ?k. R- �c�;.. a.- .?w.e.:�'..�st:..s.^:7s.s.. <br /> I I Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct in Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I — I Controlled Bum I I Hood Installation <br /> I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I 1 Fire Protection Maintenance - ANNUAL I1 Places of Assembly- ANNUAL <br /> luttnyl'bemil !Anil L'lili <br /> Sprinkler ❑ ❑ it I I Recreational Burn <br /> Fire Alarm n ❑ ❑ ❑ l I I7 Sparklers <br /> Hood Cleaning Ti ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression I 1 ❑ ❑ ❑ I 1 1 1 Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps El Waste Tire Storage ANNUAL <br /> I Fire Works <br /> n Flammable Application - ANNUAL ( ( Valuation of Project <br /> I Fuel Tanks <br /> I—I Other: I <br /> Contractor / Company Cr"? (( 1 I <br /> Signature Registered Y / N 1 Fee Current 1 Y / N <br /> Address I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y N j Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address I I License # . I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I License # I i <br /> OTHER Company J <br /> Signature Registered Y/ N j Fee Current 1 Y/ N 1 <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 (httpi /appraiser.pascogov.com) <br />