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813-780-0020 City of.ZephyrhillsFire. Fax- 813 -780 -0021 _ <br /> Permit Application =, _. <br /> 'Date Received T Phone Contact for Permit J ' u <br /> Owners Name 1 0. 7---6,_e S7 `4 I Owner's Phone Number I 0 13 1 2 N6 180 6'7 <br /> Owners Address _5 ,30 c94 J KZA.ce <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address Lot # <br /> Sub Division I I Parcel # I I <br /> Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> Q Comm Exhaust Kitchen Hood /Duct = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Burn n Hood Installation <br /> Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw a LP /Natural Gas - ANNUAL Sale <br /> ® Fire Protection Maintenance - ANNUAL = Places of Assembly- ANNUAL <br /> ilia I I rata L!i <br /> Sprinkler Li ❑ ❑ 0 n Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning ® ❑ X ❑ I I n Sprinkler System Installations <br /> Hood Suppression E] ❑ 7( ❑ I .] El Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> pi <br /> Fire Pumps r--, Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ov <br /> I 6 O©— I Valuation of Project <br /> Fuel Tanks <br /> Other: I <br /> Contractor % I , 7 y ` Company 4 6, - ; '..ek g' .--de , <br /> C <br /> Signature Registered MI Fee Current Irma <br /> Address o, Z 4 -5 q/. A fZ • 3377-5 I License # <br /> 8 - 576 3vop0 3 tQYv <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y/ N J <br /> Address I I License # I I , <br /> PLUMBER Company <br /> Signature Registered Y/ N ] Fee Current I Y/ N I <br /> Address I <br /> 1 License # <br /> MECHANICAL Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N J <br /> Address I I License # ( I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I • I ( I <br /> i 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 />