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813-780-0020 City of.Zephyrhills Fire. ot 0 ( Fax - 813- 780 -0021 <br /> Permit Application <br /> Date Received 1,. - ,x. ,n w» <br /> Contactfor Permit <br /> Owner's Name I /✓DVil G'G..e.A•v.VC xt'.e.✓ /c /A e " • I Owner's Phone Number . <br /> Owner's Address O O ' ,$ OX //9a6 TA-070. , 3 3C 7> <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> '�, � ''S'sx �x.:;a .�.✓zr.,K. ,,,_„ cam'sy�,:s ":: °.,:sid..c - �.+.' �•r" ? - .. «mss? _ �?e:- :'- , tl 1 ` ; <br /> Job Address <br /> MG ,POW.tLP 5 Go4z . GALL duck• I Lot# <br /> Sub Divisio Parcel # <br /> I 1 Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier it or RQ Facility) ANNUAL <br /> I I Controlled Bum I I Hood Installation <br /> I I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I1 Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> lUtrlyl (Semi JAFi l Other <br /> Sprinkler ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I I I Sparklers C LF..AN/ N C MLA- ae <br /> Hood Cleaning ® Xr ❑ ❑ I I I I Sprinkler System Installations <br /> 1 1 I ?)0 NE O� l�+�Q• !3 • <br /> Hood Suppression I 1 ❑ ❑ ❑ I Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation Ii Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application - ANNUAL <br /> 1 ) Valuation of Project <br /> Fuel Tanks <br /> I Other: I <br /> Contractor Company /�/OV/+ CeflN /NC S6.e!/ /GB /M!• <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address I P. Of ?O,Y, 4'9GG 7740/09.7,$3c721 License# I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N Fee Current I Y / N I <br /> Address I I License # ( I <br /> OTHER Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Addres <br /> 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 />