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813-780-0020 City of Zephyrhills Fire <br /> Fax - 813- 780 -0021 <br /> Permit Application <br /> Date Received <br /> . - - I Phone Contact for Permit <br /> ��. m Play t l : <br /> Owners Name 1 J` `�� �n1nE? �� I Q A S 1 1 6(4 I ISy�, <br /> Owner's Phone Number <br /> Owner's Address I LA u -km Oat- `Lc or B Vd - • J1 - " S n <br /> Fee Simple Titleholder Name \ I �1 ^ tip L ? V <br /> Titleholder Phone Number I 1 1 11 <br /> Fee Simple Titleholder Address <br /> Job Address Oak A L-' Ylyf h itt �1 ` <br /> `-�5 '{ 1 Lot # I <br /> Sub Division I I I ✓4 � <br /> Parcel # <br /> 1 1 Bio- Hazard Waste Storage - ANNUAL 1 1 <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier 0 or RQ Facility) ANNUAL <br /> n Controlled Bum 1I Hood Installation <br /> I I Emergency Generator < 30 kw 1 1 <br /> LP /Natural Gas - Installation <br /> 1 1 Emergency Generator > 30 kw 1 I LP /Natural Gas - ANNUAL Sale <br /> 1 1 Fire Protection Maintenance - ANNUAL 1 1 <br /> � Places of Assembly- ANNUAL <br /> IUtnyl !Semi' r" "" I IOther I ri Sprinkler ❑ ❑ ❑ I I all <br /> Bum <br /> Fire Alarm FR'... <br /> I 1p,-***.❑ ❑ I I I I <br /> Sparklers <br /> Hood Cleaning 1 1 ❑ ❑ ❑ I 1 1 I Sprinkler System Installations <br /> Hood Suppression 1 1 ❑ ❑ ❑ 1 1 1 <br /> El Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps 1 I Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- on- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor �. �._cM� 1 <br /> Signature ! Company •- lyric K .��e. C/ <br /> �� Registered Y/ N Fee Current I Y /N 1 <br /> Address I I <br /> License # 1 <br /> ELECTRICIAN! <br /> Signature <br /> I Company i <br /> Registered Y/ N J Fee Current 1 Y/ N <br /> Address 1 I <br /> PLUMBER License # I <br /> Signature ! Company 1 <br /> I Registered Y / N _I Fee Current 1 Y / N 1 <br /> Address 1 <br /> License # 1 <br /> MECHANICAL! <br /> Signature I Company <br /> Registered Y/ N Fee Current I Y / N <br /> Address 1 1 <br /> License # I <br /> OTHER <br /> Signature <br /> I Company <br /> Address <br /> Registered Y/ N I Fee Current I Y / N <br /> License # <br /> Directions: <br /> � �.. <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 h //a <br /> ( ttp: ppraiser.pascogov.com) <br />