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813-780 -0020 City of Zephyrhills Fire- q ((e D Fax - 813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit I, I Eak Iscici <br /> Owner's Name 111211 ' I Owner's Phone Number q I. b g 141 3 <br /> i <br /> Owner's Address 9 63k Ai e -runt AU. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> E ,ate e <br /> «e <br /> ilw -: # .° '�„ mss' A % .3 <br /> ....5.".wi+e..�.s'. -.a+ .eve.. '.. �'��a'r�'s° :'` n� .4:�l".r.n+�?'�?.�'.€' „ �uz$ -5 � x'x. ` w §, t .a. ' ,..1 - ,.� �,.., . i .. <br /> �.. � Lot # <br /> Job Address � 1 t <br /> Sub Division Parcel # <br /> n 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 /> Fl Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Iutnyl !semiI f hither <br /> Sprinkler El ❑ ❑ ❑ 1 Recreational Bum <br /> Fire Alarm ❑ ❑ X 1 n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Li Fire Works <br /> I I Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I I <br /> Contractor \ Company ` le 4Pu - it. � T I <br /> Signature 1 ,� �''�, ff , Registered Fee Current Y / N <br /> Address la=m • m nis License # Gr - 000 1041li <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current L Y/ N <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current 1 Y/ N I <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I { License # u� � £ I� <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 />