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813-780-0020 City of.Zephyrhills Fire j 1 t (� Fax- 813- 780 -0021 <br /> Permit Application <br /> . . . Y / /► q /� <br /> Date Received '/ IX ©S 1/ �/ 7 P ho n e Contact for Permit I 13 IS q5....17 <br /> Owner's Name h./K2-1-0 - 71-0ZV` 1- - l/ i Owner's Phone Number ,g /3 .s . 9337 <br /> Owner's Address � / " D WK 7 3e / ✓ ) / 4 FL- 33.67 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 13 I 5 AC V f 611/7 674 L I/D Lot <br /> Sub Division Parcel # <br /> Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum 1 I Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> IUtrly1 ISemi1 Other <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers <br /> • Hood Cleaning I,/ ❑ 2' ❑ ( 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I Flammable Application- ANNUAL I ( Valuation of Project <br /> n Fuel Tanks <br /> I Other: I I <br /> =ut35 %"'c:tilwW DA]r v:_v -a i?-;b> .»m'- .,'s:'a.�ac ,.n. x -. "F u. .s ,:... ✓,1 a+.re -t ": .rra s. ..:.x, S..- <. r.t.. ,:x �e.m ,a.. ..$ -f6 .c_. .�R#ri, a- .....o,e L.t: ,r..ar ..:, ,.HAJ e�-f, + 4- Ja- e:..J4 _F.:JJ.A.3.. F «: .. r._:. +".:i <br /> Contractor Company h/UfkiZ- S (0/C.----C' I - 4G-7 Signature Registered Y / N Fee Current I Y / N 1 <br /> Address I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 ( License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N j <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I • License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y / N <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 (httpJ /appraiser.pascogov.com) <br />