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813- 780 -0020 City of Zephyrhills Fire. Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received 0 j S^ 7-ezi �J Phone Contact for Permit fp / 3 ii 75 6 <br /> Owner's Name <br /> 1 Owner's Phone Number I 1 11 <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 1 1 1 <br /> Fee Simple Titleholder Address <br /> �-7 . _, °. Mrr.�a: tr��5';s;z=.*'� <br /> Job Address / 4 / 4 1 & 6,-.2.1/ 13 ". A r"b `3 Lot # 1 <br /> Sub Division Parcel # I <br /> ',r xrs - ::- �,;,:.•s.�srs �.a:::;.: :ra:,mu =r ,* s ° *,� •>.:•:a w: .Fa,: s a,. =. r_s_ a: xaa� „{.�... w- . < -: I <br /> I Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ni Controlled Bum ( Hood Installation <br /> pi Emergency Generator < 30 kw I] LP /Natural Gas - Installation <br /> El Emergency Generator> 30 kw I1 LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL Ii Places of Assembly- ANNUAL <br /> IUtnyl'Semmi r ""' 1 Other <br /> Sprinkler r1 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I l Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression 1 --- ❑ 3d ❑ 1 ( I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation (` I Torch Roofing/Tar Kettle <br /> I Fire Pumps Ii Waste Tire Storage ANNUAL <br /> I] Fire Works <br /> F-7 Flammable Application- ANNUAL I 79/OQ I Valuation of Project <br /> rI Fuel Tanks <br /> ri Other: I <br /> W <br /> Contractor '-�� " _ •sue `e , . . > <br /> Signature I ✓ <br /> S I Company m/�/G � /� - F, /'Ylc. 5 ✓ r- <br /> Registered Y/ N I Fee Current I Y / N I <br /> Address I r f c I !sG L Pict r 4.5 lvL -7-a„,./a____ I License # ( - 7/5/f d( a C.X , I <br /> ELECTRICIAN! <br /> I Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I I <br /> PLUMBER I I Company <br /> Signature 1 Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL I Company I <br /> Signature I Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER f I Company <br /> Signature I 1 Registered Y/ N . 1 Fee Current I Y/ N I <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 />