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, . <br /> . .10 Ok9 <br /> 813-780-0020 City of Zephyrhills Fire <br /> Fax- 813 -780-0021 <br /> Permit Application <br /> Phone Contact for Permit <br /> Date Received I I 1 1 I <br /> I ;LP�t(� D -I e t ' Owner's Phone Number <br /> Owner's Name (�,�, ,t� ( &-0\-1.1 ( J C. -N' I <br /> Owner's Address I Le 030 Q 1 Vd ' • l 1 1 1 I I Titleholder Phone Number l <br /> Fee Simple Titleholder Name <br /> Fee Simple Titleholder Address I <br /> I Lot# I <br /> Job Address 1 I I I <br /> 1 Parcel.* Sub Division <br /> El Bio-Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct <br /> El Hood Installation . <br /> Controlled Bum LP /Natural Gas - Installation • <br /> Emergency Generator < 30 kw <br /> LP /Natural Gas - ANNUAL Sale <br /> Emergency Generator 30 kw <br /> Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL Recreational Bum <br /> ® ml ® Other <br /> Sprinkler ❑ ❑ , Sparklers <br /> Fire Alarm ❑ ' / I I Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ ( 1 [] Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ • ❑ I I E Torch' Roofing/Tar Kettle <br /> Fire Alarm Installation = Waste lire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works I I <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> C I Company G�St • 5-c <br /> Contractor l j r ei j,(� (/ (/ Registered rows Fee Current Signature ' ���".""���� <br /> '� ' License # I E F o-O 000 y �, 0 <br /> Address 0- r w M t AI .' . C °l � • I <br /> ELECTRICIAN) I Company <br /> Registered Y / N I Fee Current 1 Y / N <br /> Signature <br /> Address I I License # <br /> PLUMBER ( Company ( <br /> Signature <br /> I Registered Y/ N I Fee Current I Y / N <br /> Address 1 I License# I I <br /> MECHANICAL I Company I <br /> Signature l Registered Y/ N I Fee Current I Y/ N. I <br /> Address I I License # I <br /> OTHER ( Company ( <br /> Signature I Registered Y/ N I Fee Current I Y/ N I <br /> Address <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 T ax Notice h //a raiser. as ov.com) <br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property (ttp: PP P ceg <br />