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.*.g9 1 <br /> 813-780-0020 City ofZephyrhillsFire. Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received O c".1.1 Phone Contact for Permit <br /> Owner's Name J 4 C, /3 e.z-i__ l Owner's / �L� �v L e 'h " »? Phone Number i Z <br /> Owner's Address 1 3� 3 �(/L �� - /'z/°" PI- 3 35 / <br /> Fee Simple Titleholder Name <br /> 1 J Titleholder Phone Number , <br /> Fee Simple Titleholder Address F � <br /> : ,. :_. , � .�. z -..' � _ � +-�. ✓,M ":; ma <br /> xY„rx. ,,,, , ,,, : :y z: ... ...i. .. xsu ?., . <br /> .�.., ,... a '.:..,,: „'.aw�<ayrc '; �:.� , . wr.r`�M - <br /> Jo.:, 7 2 t 47 E67.6- Lot # <br /> Job Address <br /> Sub Division J f 7313 q 3 d j Parcel # <br /> I Bio-Hazard Waste Storage - ANNUAL I 1 Fumigation Tent <br /> I I Comm Exhaust Kitchen H o o d / D u c t I I Hazardous Material (Tier I I or RQ Facility) ANNUAL <br /> I I - Controlied Burn I I Hood installation <br /> 7 Emergency Generator < 30 kw I-1 LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> ItttriyI I berm I vall Utner <br /> Sprinkler 7 ❑ ❑ ❑ 1 I Recreational Burn <br /> Fire Alarm 17 ❑ ❑ ❑ I I I 1 Sparklers <br /> Hood Cleaning n 0 ❑ ❑ I 1 I 1 Sprinkler System Installations <br /> Hood Suppression E ❑ ❑ ❑ 1 I I 1 Standpipes (Sprinkler Sys) <br /> I_ I Fire Alarm installation I I Torch Roofing/Tar Kettle <br /> I 1 Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works I <br /> Flammable Application- ANNUAL 1 Valuation of Project <br /> Fuel Tanks <br /> I I Other .. .- _ ,mi, k. .,‘ u <br /> Contractor Company . <br /> • <br /> Signature / Registered Y / N Fee Current Y / N <br /> Address I License # <br /> • <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered _ Y / N Fee Current Y / N <br /> Address License* I <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I •License# <br /> OTHER Company <br /> Signature Registered _ Y / N Fee Current I Y / N <br /> Address__ License* I <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 /> • <br /> • <br />