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. if/ 813- 780 -0020 City of Zephyrhills Fire �tg 0 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 1 1 Phone Contact for Permit I 813 I I 239 I 1 3473 <br /> Owner's Name I Wachovia Bank N A I Owner's Phone Number I 1 1 I I I <br /> Owners Address I P.O. Box 36246, Charlotte, NC 28236 -6246 <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 <br /> Fee Simple Titleholder Address <br /> I 5230 6th Street Job Address <br /> 1 Lot# 19 -24 <br /> Sub Division Town of Zephyrhills <br /> I Parcel # 111 26 21 0 010 15400 0190 <br /> 0 Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Comm Exhaust Kitchen Hood /Duct Il Hood Installation <br /> E l Controlled Burn I LP /Natural Gas - Installation <br /> 0 Emergency Generator < 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I — I Emergency Generator > 30 kw I Places of Assembly- ANNUAL <br /> © Fire Protection Maintenance - ANNUAL El Recreational Burn <br /> ry (Semi' mii Other <br /> Sprinkler I El ❑ ❑ n Sparklers <br /> Fire Alarm © ❑ ❑ I I n Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> Hood Suppression n ❑ ❑ ❑ I I I Torch Roofing/Tar Kettle <br /> 0 Fire Alarm Installation I—I Waste Tire Storage ANNUAL <br /> I] Fire Pumps <br /> Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> I-I Fuel Tanks <br /> 71 Other: I I <br /> /� <br /> Contractor <br /> Company an Orr Protection Systems dba Sorrell Filre <br /> Signature C t-- `'- ( / / ^ Registered Y / N I Fee Current I Y / N I <br /> Address 1 2804 Broadway Center Blvd, Brandon, FL I License# EF20000636 <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address I I License # ( I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address I I 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 />