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City of ZephyrhillsFire Fax-813-780-0021 <br /> si 7a0 -DO2D P Application <br /> + (0 1 act fat-permit ..,.....,L. <br /> Date Received 1 ,, Phone Cont <br /> �. . <br /> � ^^.'„:."°'. " °"w'„'.w' ,.:- ...'..1 . <br /> ;S - Owners Phone Number l 1 ) <br /> Owners Name ) T 1 rS� 0 Q,�G ± ' " - `�"_ <br /> Owner's Address - 6b2 ( S -. — OL Aut./Now ---- b-elL■iik fl . S/35" - ci <br /> l Titleholder Phone Number <br /> Fee Simple Titleholder Name J <br /> Fee Simple-Titleholder Address xs ww .' „ - ".. <br /> ii::u, k .id3c.�;e.. W h ..:4:..` '^t 10 Gl, .. n__ j _. y I .. <br /> Lot N <br /> Jab Address <br /> Parcel # <br /> Sub Division 1 <br /> ''' r Fumigation Tent <br /> Bio-Hazard Waste Storage - ANNUAL <br /> n Comm Exhaust Kitchen Hood/Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n - Controlled Burn J . 1 Hood Installation <br /> 1 n LP /Natural Gas - installation <br /> Emergency Generator < 30 kw <br /> I I 30 kw LP /Natural Gas - ANNUAL Sale <br /> Emergency Generator> w <br /> I I Fire Protection Maintenance - ANNUAL J 1 Places of Assembly- ANNUAL <br /> zap ',Semi! rall 1 <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ J I J I Sparklers <br /> ypgd.Glegning 2 ❑ ❑ ii i 1 J I Sprinkler System Installations <br /> Hood Suppression E ❑ ❑ ❑ 1 1 • 1 Standpipes (Sprinkler Sys) <br /> Fire Alarm 1 Installation Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 1 Valuation of Project <br /> 1 --- 1 Fuel Tanks <br /> 17 Other: J <br /> Company . 4 7-400,14- Contractor <br /> Signature &' C-� II Registered Y / N Fee Current Y / N <br /> 1 <br /> Address i License # 1 - <br /> ELECTRICIANI Company <br /> Signature 11 Registered Y/ N I Fee Current I Y/ N <br /> Address ( License # <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address J License # <br /> MECHANICAL Company <br /> Signature . Registered Y / N 1 Fee Current Y / N • <br /> Address I l - License* <br /> OTHER • Company <br /> Signature Registered Y / N I Fee Current t Y / N <br /> nis iress • License* I <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarised (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 /> • <br /> • <br />