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City ofZephyrhillsFire• <br /> Fax -813- 780 -0021 <br /> 81; 7so -ouzo Permit Application <br /> - Phone Contact for Permit I 1 -1 <br /> D t a Received .� K � • <br /> Y E- 'Or 1 1.1.5 fin4 Owner's Phone Number <br /> Owner's Name �EP� `„ �� 1 ' 1 ' <br /> Owner's Address <br /> 3 110 01L71/ 4-v" zt%P# I !C_t S <br /> Titleholder Phone Number 111 <br /> Fee Simple Titleholder Names <br /> Fee Simp Titleholder Address — tom" <br /> �n� n ` s' tur N s,.' <br /> 4E'. M. .�. 3 S f <br /> Job Address I/ W K <br /> Sub Division Parcel Fumigation Tent it <br /> 1._,.,. n[d:..,a•.i.:,.�.o..;�� +iz.�bw. u.S�ri+�. 'v�3,`1::�i'rti''"'..m.,,�. «,: >.' ": .. h., :..: r., <br /> 1 Bio-Hazard Waste Storage ANNUAL <br /> Hazardous Materia (Tier II or RQ Facility) ANNUAL <br /> 1 Comm Exhaust Kitchen Hood /Duct - Controlled Bum L j � Hood installation <br /> 1 I � <br /> u LP /Natural Gas - Installation <br /> mergency Generator < 30 kw C LP /Natural Gas - ANNUAL Safe <br /> 1 I Emergency Generator> 30 kw T�'31 Places of Assembly - ANNUAL <br /> J I Fire Protection Maintenancee ^ ANNUAL EaEll l = C <br /> Sprinkler <br /> 0 0 Recreational Bum <br /> Fire Alarm <br /> 1 0 ❑ Sparklers <br /> HoCle <br /> � 9 0 C Sprinkler System installations <br /> Hood aning <br /> Hood Suppression <br /> C 0 9 Standpipes (Sprinkler Sys) <br /> .1 1 Fire Alarm Installation 1 I Torch Roofing/Tar Kettle <br /> 1 I Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> 1 Fire Works Valuation of Project <br /> I Flammable Application- ANNUAL 11111111111111111111 <br /> l Fuel Tanks <br /> I Other: 1 _nmctt. <br /> Company <br /> Contractor `�btf �D Fjk. � f , Registered Y/ N � Fee Current � Y/ N <br /> Signature {(•, l� �-c I 1 <br /> License # <br /> Address <br /> Company <br /> ELECTRICIAN Registered Y/ N 1 Fee Current 1 Y / N <br /> Signature 1 1 1 � <br /> License # <br /> Address <br /> l Company <br /> PLUMBER I I Registered Y/ N I Fee Current Y/ N <br /> Signature I I <br /> License # <br /> Address 1 <br /> l Company <br /> MECHANICAL I Registered Y / N ( Fee Current Y / N <br /> Signature <br /> License # <br /> Address 1 <br /> Company <br /> OTHER Registered Y/ N I Fee Current Y! N <br /> Signature <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 ( p pP p g htt //a raiser. asco ov.com <br /> ) <br />