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City of ZephyrhillsFire• Fax -813- 780 -0021 <br /> 813-780-002 permit Application 1 <br /> Phone Contact for Permit <br /> Date Received �. �aa� <br /> A , e Ai //��A7 ��/i�11� 'Owner's Phone Number l <br /> Owners Name i L �/ <br /> Owner's Address 1 I 1 <br /> Titleholder Phone Number 1 j <br /> Fee Simple Titleholder Name <br /> Fee Simple Titleholder Address ¢s = - -t"� "' "' "" Mp <br /> 4004 i <br /> Jab Address W I_" "� — l INIIINIIIIIIIIIIIIIIIIIIIIIIII Parcel # l - - - <br /> Sub Division <br /> &L:�, i::ua• <br /> Fumigation Tent <br /> Sio-Hazard Waste Storage - ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct <br /> Hazardous Material (Tier II or RC) Facility) ANNUAL <br /> 1 - Controlled Bum I C Hood Installation gig/ <br /> I 1 <br /> ! LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw LP /N - s- ANNUAL_c�Q_�� <br /> Emergency Generator> 30 kw <br /> WI Places of Assembly -ANNUA <br /> Fire Protection Maintenance - ANNUAL of A <br /> iutny, lSemlI 0 / 1 <br /> � <br /> Recreational Bum C <br /> Sprinkler Li 9 0 0 C 1 Sparklers <br /> H re C e I I <br /> Sprinkler System installations <br /> Hood Cleaning 0 0 0 <br /> j 1 D p Standpipes (Sprinkler Sys) <br /> Hood Suppression 1----1 <br /> Fire 1 Torch Roofing/Tar Kettle <br /> 1 I e Alarm Installation Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> I I Fire Works Valuation of Project <br /> 1 1 Flammable Application- ANNUAL <br /> ,1 I Fuel Tanks <br /> n Other: 1 11 <br /> Company <br /> Contractor / Registered L Y / N I Fee Current I Y / N <br /> Signature ✓ j,C / -%1 - ' �� � � 1 <br /> I License # <br /> Address l . <br /> Company <br /> ELECTRICIAN Registered Y/ N 1 Fee Current I Y / N <br /> • Signature j <br /> Address 1 I License # <br /> Company <br /> PLUMBED, Registered Y / N I Fee Current Y / N <br /> Signature I <br /> Address 1 I License # <br /> MECHANICAL Company <br /> • Registered Y / N Fee Current I Y / N I <br /> Signature <br /> Address I I -License# <br /> OTHER I Company <br /> JI • Registered Y / N Fee Current Y / N <br /> Signature I <br /> Address .. L <br /> icense <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 / /app raiser. asco ov.com <br /> p 9 ) <br />