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813- 780 -0020 City of Zephyrhills Fire 4r q 2/0 1 Fax -813- 780 -0021 <br /> • Permit Application `fi <br /> Date Received Phone Contact for Permit <br /> Owner's Name 1 K T P 6' on #120 et /i41 I Owners Phone Number 1 6 117 ,33 I F I `? / /q <br /> Owner's Address 1 3 lig 9 4 A re . .3t) l 'd ) / L J i q 7 <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I I I I <br /> Fee Simple Titleholder Address I <br /> Job Address 1 5 Y 9 r: ? VE 2- rqh /II s ! ..- ... 351-/O 1 I Lot # i , ......w, e., .... <br /> Sub Division I °` ° I Parcel # <br /> E Bio -Hazard Waste Storage - ANNUAL El Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 11 Comm Exhaust Kitchen Hood /Duct I Hood Installation <br /> E Controlled Bum ri LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw 1 LP /Natural Gas - ANNUAL Sale <br /> Emergency Generator > 30 kw <br /> R n Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL rI Recreational Bum <br /> an Mull (J Other <br /> Sprinkler 11 ❑ ❑ n Sparklers <br /> Fire Alarm ❑ ❑ 6l' I 1 n Sprinkler System Installations <br /> Hood Cleaning E ❑ ❑ ❑ ( 1 I1 Standpipes (Sprinkler Sys) <br /> Hood Suppression E ❑ ❑ ❑ 1 1 n Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation 71 Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> E Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> 0 Fuel Tanks <br /> Q Other: I I <br /> Contractor /�1 Company <, r;, sees - <br /> Signature (J��" Registered , / N I F / Fee Current I Y/ N I <br /> Address ( License # ( F1 I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I <br /> I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # <br /> d ons . .. F _ ., <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 />