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3 13 780 -0020 City of Zephyrhills Fire• '{' 6 3 ( Fax -813- 780 -0021 <br /> Permit Application l <br /> Date Received RIF • - Phone Contact for Perrnit <br /> Wills oZ 3 Q 4/ <br /> ` <br /> Owner's Name 1 5 @M 1r°X � n <br /> 6 iA e /l Owner's Phone Number 1 ' 1 I <br /> Owner's Address 17 of oak c 13)V el Tamp j F L 33 <br /> Fee Simple Titleholder Name 1 Titleholder Phone Number <br /> 1 <br /> Fee Simple Titleholder Address <br /> . � / :sg - :tQ <br /> Job Address 1�a A Th1ry Rd. ze / 4yi ii b ) FL 33SI0 Lot # <br /> Sub Division Parcel # <br /> IT Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct r---1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum pi Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw El LP /Natural Gas - ANNUAL Sale <br /> I — I Fire Protection Maintenance - ANNUAL r Places of Assembly- ANNUAL <br /> r y (semi 1 Other <br /> Sprinkler © CI ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ .❑ I I n Sparklers <br /> Hood Cleaning ❑ 1:1 0 I I [ ] Sprinkler System Installations <br /> I I <br /> Hood Suppression ❑ ❑ ❑ I 7 Standpipes (Sprinkler Sys) <br /> pi Fire Alarm Installation El Torch Roofing/Tar Kettle <br /> _ I Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I Flammable Application- ANNUAL ` 1 Valuation of Project <br /> I Fuel Tanks <br /> TI Other: I <br /> Contractor Company 3 Cyri C( I <br /> Signature Registered Y/ N f Fee Current 1 Y/ N <br /> Address ( ` <br /> I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N J Fee Current I Y / N <br /> Address I <br /> I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y / N J <br /> Address I <br /> 1 License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address <br /> 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 />