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City ofZephyrhillsFire. , Fax-813-780-0021 <br /> $; 7s0 -DD?D Permit Application <br /> Date Received i �wmw Phone <br /> Phone Contact for Permit <br /> Owner's Name fir 6 RAA'`V / 5 7. t,c_ _ Owner's Phone Number . `v ' Z- S o`f d q <br /> Owner's Address ' 3 (Q 7 0 0 i 04- ---Z^ LL --c-3 .S.14-2 <br /> Titleholder Phone Number , <br /> Fee Simple Titleholder Name <br /> Fee Simple Titleholder Address �� fi ...�. �. ,,. ,,...,.. <br /> 4 rr€ r t..r' 'tea <br /> .. r ,,, Yam..* wx �i�..0 .. .. : .3. ,.. �, -.:: f4 ,+. , >'.;,.:, n3._ ., ...: : , . . . ::... �: <br /> . ...,. : Yrx. .*av :..cS.. �rv.-..r.� � , 'sewv;.M <br /> Jo .,.x.. dd , Lot # <br /> Job Address <br /> 1 Parcel # <br /> Sub Division J <br /> Bio-Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I - Controlled Bum I 1 Hood installation <br /> I 1 Emergency Generator < 30 kw 1 LP /Natural Gas - Installation <br /> Emergency Genetator> 30 kw <br /> LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL El Places of Assembly - ANNUAL <br /> ) dtrry 1 1 Semi I raj l Utner I <br /> Sprinkler 1 ❑ ❑ ❑ I j I 1 Recreational Bum <br /> Fire Alarm I I ❑ ❑ ❑ I I 1 1 Sparklers <br /> Hood Cleaning 1 ❑ ❑ ❑ 1 1 1 I Sprinkler System installations <br /> Hood Suppression 1 ❑ ❑ ❑ 1 1 I 1 Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> ) I Fire Pumps 1 1 Waste Tire Storage ANNUAL <br /> 7 Fire Works <br /> 1, 1 Flammable Application- ANNUAL 1 Valuation of Project <br /> - Fuel Tanks <br /> I 1 Other: I <br /> Contractor Company . <br /> • <br /> Signature Registered Y / N Fee Current Y / N Address , License # <br /> ELECTRICIAN Company <br /> Signature • - Registered _ Y / N Fee Current Y / N <br /> • <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current l Y / N <br /> Address 1 License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address License # I : <br /> OTHER, ' —' Company <br /> 9 <br /> Si nature �� " `' //' _ Registered Y / N Fee Current 1 Y / N <br /> Address Mr 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.(Mechanicat 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 /> • <br />