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813-780-0020 <br /> City ofZephyrhillsFire• Fax- 813-780 -0021 <br /> Permit Application <br /> Phone Contact for Permit <br /> Date Received 6'/2 , � P „ .,__ M _cW... <br /> Owner's Phone Number 1 <br /> Owner's Name � - - <br /> Owner's Address .9CP3' Z#'49--e--e---- ! ' <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Name <br /> 1 <br /> F <br /> Simple 717:M 111, Address t ,t �,,,, ,_ 1_ .., Drys omo <br /> .. � ��r.�.. "" rW+.}. r.L,x ...; � i .r <br /> .: A ... -y �:. i w,.... � :rx�...,,�.A�w`�� �.. ��. r. .+e...�..J�''.r��Y4M�4�tE.'x�t� '+'c"i /� / .. ...� —� J Lot # 1 � .. <br /> � . -- ,e; 1---- ( / �� 7 "!mil <br /> Job Address 1 � 6 3 <br /> Parcel # � <br /> Sub Division f <br /> ,.=,a rse, rv.. . <br /> 1 Fumigation Tent <br /> Bio-Hazard Waste Storage - ANNUAL <br /> 1 I Comm Exhaust Kitchen Hood/Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I - Controlled Bum I Hood Installation <br /> 1 LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw <br /> 1 Emergency Generator> 30 kw ,�. 1 LP/Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL � 1 "' maces of Assembly-ANNUAL <br /> )UtnyJ 1semi ! " rtner 1 <br /> Sprinkler ❑ ❑ ❑ 1J Recreational Bum <br /> Fire Alarm I I . ❑ ❑ ❑ 1 1 I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression LJ ❑ ❑ ❑ j I 1 Standpipes (Sprinkler Sys) <br /> 1 Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> Fire Pumps J Waste Tire Storage ANNUAL <br /> I Fire Works <br /> 1 Flammable Application- ANNUAL . ` f Valuation of Project <br /> , .1 1 Fuel Tanks <br /> 1 Other: 1 <br /> Contractor - ` 7 7 ,„•--- 7 ,„•--- „. S • -��tj, Company . / 5 - <br /> Signature <br /> : 3 Registered Y / N Fee Current Y / N <br /> Address 111W 9f- iri/ /" / / . . License # <br /> ELECTRICIAN Company - Signature • Registered _ Y / N Fee Current Y / N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current 1 Y / N 1 <br /> Address -License # _ <br /> OTHER. Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address. ( L i. nse <br /> Lice <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 /> • <br />