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City ofZephyrhillsFire. Fax - 813 -780 -0021 <br /> s1 r7aD -ouzo Permit Application <br /> Phone Contact for Permit I $/3 11 /91(> i a <br /> Date Received 4: a . ,.m :_..,..., - z,,.4,- <br /> 1YZ� <br /> ,,,1 4 - yAn I n f ��, 4 , t 1-- I Owner's Phone Number J /5 /3 7$Z• 7770 <br /> Owner's Name J /iiq� nr� - -� '�/ e� I � <br /> Owner's Address <br /> S 9 /= 57- 2 /Kyi 0 <br /> Titleholder Phone Number <br /> Fee Simple - Titleholder Name J <br /> Fee Simple Titleholder Address fi � • -• "� " " "' "" <br /> i� =m�e+ � w r .zi, C�^ <br /> .." �_.,:. "..u„".:,a.�;.„".,..'-�s "",1:.. ,,,,... ,, 2.--e_ , `t i ) � L ot # • <br /> Job Address .:D 3 - / ,J' <br /> Parcel # <br /> Sub Division ur • .n ..,,,. ..,,,..: <br /> „_- ;�s;aµ,:�u.:..N.�.i:�,*y,a:"�'' •' '�� - Fumigation Tent <br /> I Bio-Hazard Waste Storage - ANNUAL I <br /> 1 I Comm Exhaust Kitchen Hood /Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Hood installation <br /> 1 - Controlled Burn 1 LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw <br /> I I 1 LP/Natural Gas - ANNUAL Safe <br /> i Emergency Generator 30 kw 1 Places of Assembly- ANNUAL <br /> 1 Fire Protection Maintenance - ANNUAL <br /> )utriyl' }semi( DM Utner <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> 1 ❑ ❑ ❑ I 1 Sparklers <br /> Fire Alarm <br /> Hood Cleaning J <br /> r' ❑ ❑ ❑ I 1 1 Sprinkler System Installations ID ( 1 Standpipes (Sprinkler Sys) <br /> Hood Suppression _12 ❑ <br /> Fire Alarm Installation 1' Torch Roofing/Tar Kettle <br /> 1 1 Waste Tire Storage ANNUAL <br /> 1 Fire Pumps <br /> Fire Works Valuation of Project <br /> 1 1 Flammable Application - ANNUAL <br /> I I Fuel Tanks <br /> 0 Other: <br /> :,:��. _ ..,: •YEA- ., -_.. ._ .. -.- -. <br /> Company <br /> Contractor <br /> �j Registered l Y/ N I Fee Current I Y/ N <br /> Signature / • Address 1 I License # 1 <br /> ELECTRICIAN Company 1 Signature Registered Y/ N I Fee Current L Y/ N <br /> Address I 1 License* 1 <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current l Y / N <br /> Address 1 1 License # I <br /> MECHANICAL 1 Company <br /> Signature Registered Y/ N Fee Current 1 Y / N <br /> Address 1 1 • License# I <br /> OTHER Company <br /> Signature I Registered Y/ N I Fee Current 1 Y/ N <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 (http: / /appraiser.pascogov.com) <br /> • <br />