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813-780-0020 City of Zephyrhills Fire- Fax . <br /> Permit Application <br /> /ate Receives 1 Phone Contact for Pam* 1" ----- 1 1 1 ----- <br /> hnrnees Name t5aStiffidd—hikerfei J Owner's Phone Number Ii-12 1 4>Isz MEM <br /> )wner's Address I c VW:33 ,....SOU 14 ,p4 Vt <br /> 'se Simple Titleholder Name Titleholder Phane Number 1 1 1 1 <br /> , ee Simple Titleholder Address I I <br /> ob Address Lot # I <br /> ;ub Division Parcel # I <br /> ri Bio-Hazard Waste Storage - ANNUAL r Fumigation Tent <br /> fl Comm Exhaust Kitchen Hood/Duct ni Hazardous Material (Tier [for RQ Facitity) ANNUAL <br /> El Controlled Bum ni Hood Installation <br /> 1 - 1 Emergency Generator <30 kw ri LP/Natural Gas-Installation <br /> r --- 1 Emergency Generator > 30 kw . LP/Natural Gas-ANNUAL Sale <br /> ri Fire Protection Maintenance - ANNUAL r---1 Places of Assembly-ANNUAL <br /> VIM r [Ell timer <br /> Sprinkler El 0 0 0 ri Recreational Bum <br /> Fire Alarm E 0 0 0 1 1 1 1 Spenders <br /> Hood Cleaning 1:D 0 0 0 1 1 r1 Sprinkler System Installations <br /> Hood Suppression /gf 0 XI 0 1 1 r Standpipes (Sprinkler Sys) <br /> r - i Fire Alarm installation 1 I Torch Roofing/Tar Kettle <br /> Fire Pumps <br /> Waste The Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL r---i <br /> 1 I Valuation of Project <br /> El Fuel Tanks <br /> r Other: I <br /> I <br /> Contractor • Company I <br /> Signature Registered YIN J Fee Current 1 YIN I <br /> Address I License # I <br /> ELECTRICIAN' . Company I <br /> Signature Registered Y/N I Fee Current I Y/N I <br /> Address I Ucense # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I <br /> I license # I <br /> MECHANICAL Company I <br /> Signature Registered Y/N j Fee Current 1 YIN I <br /> Address I <br /> I License # 1 <br /> / <br /> OTHER <br /> Company 4 . ..2..S. - <br /> Signature , Registered MEI Fee urrent Waal <br /> Address was c) „,,,f License # 62 — ..., PAIS Z <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 />