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813 - 780 -0020 City of Zephyrhills Fire 1+q2((i / Fax - 813 - 780 -0021 <br /> Permit Application G cjc e <br /> Date Received Phone Contact for Permit ` PM werri <br /> :4 / / / rte <br /> Owner's Name M% 9/. � , al �AW� Owner's Phone Number ( ( 7' 1 I � ?�� ( /i`; /' <br /> Owner's Address / , 2 / /�i,: �I ��1- ..bem /s CCe-' <br /> Fee Simple Titleholder Name L Titleholder Phone Number I I 1 I <br /> Fee Simple Titleholder Address I <br /> ,,.: 'fii�:'^,,"tn��e..m ` -' g - a,a '1 ,.`i:.�.w :'�,. �- `':r.. .:. � d'.i;i ,,,� a.�t' v`�:�.. .�v°'a �b�'k,i4ra">:a�sµ'.A..aa. - a r•Y tak 3?aXU:a..�;. mEb�°;:�:_. . �-„ �x,. 1. .ais.'Ga'�. "..�'a5;s: -,a "a <br /> Job Address J U d �G�� .440, A� Lot # , <br /> Sub Division I//1J „I Parcel # I <br /> & "4SR��'.;�#�'S;�'a.y,?�a?56 mn"�•-,.., nA ri'��c+fix $.,�""..a r.�w "fix dfi,. �� ;�. . `_. ^ `.�." '".'WC� "- 5'y�" "€..`.;;�k w�winsJa„� ° ;;`#`,.:. �, s,. n'.�aS�Tc�rdR �,.'ar:!se�+"'w.: <br /> a Bio- Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood /Duct Hood Installation /J <br /> n Controlled Burn n LP /Natural Gas - Installation (,... i <br /> El Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale eU/- , -I- <br /> El 6ii <br /> Emergency Generator > 30 kw n Places of Assembly- ANNUAL ,,,,,, / //_ 1' ? ,-� <br /> El Fire Protection Maintenance - ANNUAL n Recreational Burn 7' S� 7 [� / <br /> ry z • - ® Other / <br /> Sprinkler D ❑ ❑ ❑ n Sparklers <br /> Fire Alarm El ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Cleaning CI ❑ ❑ ❑ ( 1 n Standpipes (Sprinkler Sys) <br /> Hood Suppression El ❑ ❑ ❑ I I n Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> n Fire Pumps / <br /> E Fire Works <br /> n Flammable Appli <tion- ANNUAL I le mo I Valuation of Project <br /> 0 Fuel Tanks I <br /> Q Other,. 4 j <br /> Contractor ie i/t - Company F. ( , <br /> Signature <br /> ' V s �� Registered Y/ N 1 Fee Curren I Y/ N 1 <br /> �/ <br /> Address rii'�mi wiztiminsw ' - License # ( I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address 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 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 /> FiII 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 />