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, tre , qm <br /> 813 -780 -0020 <br /> City ofZephyrhillsFire, Fax - 81,E -780 -0021 <br /> Permit Application <br /> Date Received — Z —C7 I N it .— ._...._..... ,. 7., .. ...-. ,�.., _ ..„.....,..,.. <br /> Pho Contact for Permit 0/Y 3 ft 65 9 <br /> 15./.9e -ratio Owner's Phone Number 2/3 7.8 1ao2,5 <br /> Owner's Name o �F � ✓r•3�` ��`�L" <br /> Owner's Address 3Gir ( C( b 335 <br /> Titleholder Phone Number 1 <br /> Fee Simple Titleholder Name <br /> Fee Simple Titleholder Address M.... _..,r r... Y x w,. <br /> (o 15 k l 1 C 1,"L C...,-,.e_ -5) r 2 --e v 1^--j 1^--j Lt . \ \ 335 Lot # <br /> Job Address <br /> 1 Parcel # <br /> Sub Division J .• s.,, =«a. <br /> Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I - Controlled Burn I Hood Installation <br /> 1 Emergency Generator < 30 kw I LP /Natural Gas - installation <br /> Emergency Generator> 30 kw <br /> I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL <br /> I � I Places of Assembly - ANNUAL <br /> — jUtrly] ''Semi! 1 jutner <br /> Sprinkler ❑ ❑ ❑ 1 Recreational Bum <br /> Fire Alarm I 1 ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 1 1 I Sprinkler System Installations <br /> Hood Suppression ❑ ,Ic ❑ 1 1 1 1 Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> 1 Fuel Tanks <br /> n Other: <br /> Contractor --- Company <br /> Signature <br /> : Registered L Y / N Fee Current Y / N <br /> _ <br /> Address License # I <br /> ELECTRICIAN Company <br /> Signature .. <br /> Registered Y / N Fee Current Y / N <br /> Address I License # . <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current - Y / N <br /> Address I 1 License # <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 Y / N <br /> Address License Of <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 (httpj /appraiser.pascogov.com) <br />