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813-780 -6020 City of Zephyrhills Fire 1 ( Fax -813- 780 -0021 Permit Application Date Received I 1 Phone Contact for Permit I I I I I I Owner's Name 12Q,PheloCILS Plaza., LLC.- 1 Owner's Phone Number 1 g' 1 I 17b (tabgb Owner's Address 590 LP CO `"'Q tAX iu 9 .N� 0CP Fee Simple Titleholder Name I 1 I Titleholder ' `- itleholder Phone Number I Fee Simple Titleholder Address I 1 Job Address 749-5 G o-- 6&4d- i vy► v ' `U" I J ' v 351-11 �( Lot # jy Sub Division 1 (J I Parcel # 34- 2 g 1 .01 (0 ot 00I 00 . MO El Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL n Comm Exhaust Kitchen Hood /Duct n Hood Installation n Controlled Burn n LP /Natural Gas - Installation n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale r[-cc Emergency Generator> 30 kw L_J Places of Assembly-ANNUAL I x I Fire Protection Maintenance - ANNUAL r-i Recreational Burn 't IQtrlyl Semi) Other Sprinkler I I n ❑ ❑ $ 0 Sparklers Fire Alarm El ❑ ❑ ❑ I 1 [] Sprinkler System Installations Hood Cleaning El ❑ ❑ ❑ I I I—I Standpipes (Sprinkler Sys) Hood Suppression CI ❑ ❑ ❑ I I [] Torch Roofing/Tar Kettle In Fire Alarm Installation Waste Tire Storage ANNUAL n Fire Pumps Fire Works n Flammable Application- ANNUAL I I Valuation of Project Fuel Tanks n Other: I I Contractor Company 1 Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # ( 1 ELECTRICIAN Company 1 Signature Registered Y/ N I Fee Current I Y/ N I Address I License # ( 1 PLUMBER I Company I Signature I Registered I Y / N 1 Fee Current 1 Y / N I Address I License # I MECHANICAL Company 1 Signature Registered Y/ N I Fee Current I Y/ N I Address I 1 License # 1 OTHER Company 1JRYNE AMTE MPet1G F 2-6 SP9-40 GI ' Signature te __- ij FERN ., Registered MUM Fee Current �■ I Address li p CH'QJe- Y I ALM ®� �/k�/�P�F ?i L o 1 I License # I 09b4(0( 0 abOI a- IC0i5 I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)