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813 -780 -0020 City of Zephyrhills - Fire (- <br /> Permit Application <br /> Date Received ,3 /`o) ( Phone Contact far Permit J 8/ 3 1 r4, I a Fr/ <br /> ... ......., r. ,- N,;..:.� • ..... , ;:• : zGa . ..mr::u,,. _ ., z sz. ,. x . : rs =: „� ss , a. ; rr a 's. _: :.ter:....; ..._ ,u. ...., <br /> Owners Name S i rnplPx £ r 14 n e 11 1 Owners Phone Number - <br /> I <br /> Owners Address 470 1 Oa lc- PG 1'” Vac,. 74m 1 FL- 33 , / 6 <br /> Fee Simple Titleholder Name 1 Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> ..::« € '" a,' -a^ „ K?& 1' :, -:. :, S ^ x £1• . c, 3 aa -” :- rsh�r ,>;�ra Z 'r.;,, "'€-1 •i^x..n >, xr ":tw: '- ,.',#'••, ..- •,,,- , e' -- i« i .:^.',+, n , - , " - '1 . & �= "�§ a ;ia =.a. `. -.?^ ' ,e4.4 "- -r :t.. <br /> 5 ` <br /> Job Address 705 �I 8 /✓ / d 2e ohyrl�i l 11 S ' r L 3351111 Lot# <br /> r <br /> Sub Division Parcel # <br /> t�.& .: ,^.. :'r.,,� �:' -• :� :*a.:_e.. = .= �...a...,�.a?ra...: =ax.; a,. _.:�ara;v..x: iam - �.::_ - •mac - _*ras= �'::.K. °a M.:" r ..-:•,z...i�:� <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 /> 1 1 Emergency Generator < 30 kw 1 1 LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL 1 1 Places of Assembly- ANNUAL <br /> jUtrly) 'Semi 1 Other - <br /> Sprinkler N1 ❑ ❑ rte. e y.f) 1 Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ I 1 1 I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation nr Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> pi Fire Works <br /> 1--- ( Flammable Application- ANNUAL I 1 Valuation of Project <br /> n Fuel Tanks <br /> F Other: I <br /> Contractor / Company .' 4 i' `L�F.c. t( 1 <br /> Signature <br /> / Registered Y / N I .►v <br /> Fee Current Y/ N I <br /> Address 1 License # I <br /> ELECTRICIAN Company 1 <br /> Signature Registered Y/ N j Fee Current 1 Y / N 1 <br /> Address 1 I License # 1 I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N 1 <br /> Address ( I License # . I <br /> MECHANICAL Company 1 <br /> Signature Registered Y/ N _I Fee Current 1 Y/ N J <br /> Address 1 I License # 1 <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N j <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 (httpJ /appraiser.pascogov.com) <br />