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813 - 780 -0020 City of Zephyrhills - Fire• i 1)-f <br /> I Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received (D 0 - Phone Contact for Permit g 3 le al 3 ?g/ <br /> �'� m ` - � :3.c <br /> Owner's Name 5) M elf) t7 r,nn e 'I Owner's Phone Number <br /> �/` I <br /> Owner's Address ''?o f O K F Blvd/. Tciva FL 336), n <br /> Fee Simple Titleholder Name J Titleholder F'hone Number <br /> Fee Simple Titleholder Address I <br /> : ac§-. �iS`l-.':. .??a`s6'.i`.Yllwze2 V"'YstS -`i., Y. z.'< +.^�.fi.�ei.lxt. tYM'F- SAn,3iFl,Y' mod.- �'-e..:' y `$ ✓..e' ; <br /> Job Address JO c0 &a// Zlve_ Zeo r h S FL 33S `4 I Lot# <br /> Sub Division Parcel # <br /> �:r ,.r�:: <,, :,.,z« =. Mazur-:.. _„,.:.;....,;.a,w:r.�..::aax, ...'Gans:, '^:.e:_..,s•:�� <br /> { <br /> I Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> 1 1 Comm Exhaust Kitchen Hood /Duct in Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum I Hood Installation <br /> I 1 Emergency Generator < 30 kw h LP /Natural Gas- Installation <br /> I I Emergency Generator> 30 kw I I I LP /Natural Gas - ANNUAL Sale <br /> 1 Fire Protection Maintenance - ANNUAL --.' P 1111 Places of Assembly- ANNUAL <br /> / (Utny jSemil n egia. <br /> Sprinkler I I LE ❑ Er ram - Recreational Burn <br /> Fire Alarm n ❑ ❑ ❑ I 1 I 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ ( 1 1 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I ( I Standpipes (:3prinkler Sys) <br /> El Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps I Waste Tire Storage ANNUAL <br /> 1 ---- 1 Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> fl Other: I <br /> Eft <br /> Contractor r der Company '3 cy." t( I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I ` I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y N I Fee Current I Y/ N I <br /> Address ( 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 1 Fee Current I Y / N_I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y / N Fee Current Y / N <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 /> tf 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 />