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813 -780 -0020 City of Zephyrhills Fire R 110 Fax- 813- 780 -0021 <br /> Permit Application <br /> Date Received — I 1 Phone Contact for Permit I 1 I 1 1 I <br /> Owner's Name I j 4 1 rj .67,/ P Tls ) / 0 N ii ) ,_,� / 1 I Owner's Phone Number I Ri 3 I I 7a 11 1 CSe I <br /> Owner's Address I S c'1 �y Lo 3 q N (it) y. .5 L' AS "T 2 L f-1l y R Jf f L L .s / t -' 4. 3� J SL I <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 I 1 1 I <br /> Fee Simple Titleholder Address I I <br /> Job Address 1 3 e 6 3 1 -1- /f 1 Y s L-ris r. 2 rr p it y R N 1 L L s, p . 2 j-Li-)--I Lot # I <br /> Sub Division <br /> 1 Parcel# I G,Z -,,aL 2 1-QDov. -v /y.v6 40 I <br /> E Bio -Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood/Duct n Hood Installation <br /> Controlled Burn n LP /Natural Gas - Installation <br /> 0 Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> 0 Emergency Generator > 30 kw [ Places of Assembly- ANNUAL <br /> D Fire Protection Maintenance - ANNUAL n Recreational Bum <br /> r" m i IEEI m a <br /> Sprinkler Li "'� 1 ❑ ❑ ❑ n Sparklers <br /> Fire Alarm 0 ❑ ❑ ❑ I ( n Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ I ( n Standpipes (Sprinkler Sys) <br /> Hood Suppression El ❑ ❑ ❑ I ( n Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL 1 <br /> Fuel Tanks <br /> Q Other: I I <br /> Contractor pc,_ �' Company <br /> Signature L �_"____ Registered Y / N I Fee Current I Y / N <br /> Address I I License # I I <br /> ELECTRICIAN I <br /> Company I <br /> Signature Registered Y/ N I Fee Current I Y 1 N I <br /> Address I I License # I I <br /> PLUMBER I Company <br /> Signature I Registered Y/ N J Fee Current I Y/ N I <br /> Address ( I License # I <br /> MECHANICAL! <br /> I Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( I License # <br /> OTHER ! Company I <br /> Signature I Registered ! Y/ N I Fee Current I Y/ N I <br /> Address I I License # I 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 party Tax Notice (http: / /appraiser.pascogov.com) <br />