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813 -780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received Z , - U Phone Contact for Permit <br /> Owner's Name 1 L L/# - Yb ' t L/ c -fib 4 1 Owner's Phone Number ( 1 1 I <br /> Owner's Address 1 2. k. !It ` /il C. J F ( 33i <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I I <br /> :.a.> � .... <br /> Job Address q-,336 2.I 1 _. '— Lot # <br /> Sub Division I ( Parcel # I <br /> E Bio-Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Q Comm Exhaust Kitchen Hood /Duct = Hood Installation <br /> Controlled Bum I] LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw El LP /Natural Gas - ANNUAL Sale <br /> El Emergency Generator > 30 kw = Places of Assembly- ANNUAL <br /> El Fire Protection Maintenance - ANNUAL Recreational Bum LIMN <br /> Sprinkler �' + (/�'� ❑ ❑ LJ Sparklers <br /> Fire Alarm El ❑ ❑ ❑ I 1 E Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ I I E Standpipes (Sprinkler Sys) <br /> Hood Suppression Ej ❑ ❑ ❑ I 1 0 Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation I Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> CI Other: <br /> : �1 }4 .::,, @. ^i_b�.vL. - a t>a, �. ., , -.. , .4Y x,..::A3.S�?,,.kX Le:� >,,.r- m.f.'&Si. �tN�iK�esF Sit'=$ F` � W;_ zi?. AMma�:.' 'G. X...,w'°+l^�,�i * .w w4 `4� E.,47e �'.,a kb?.4'ks <br /> Contractor / Company j-i.i - KN9Z2Dr9'. /f filto e-cciew _.2 <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y / N I 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 />