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813-780-0020 City of Zephyrhills'Fire. Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received I - Phone Contact for Permit <br /> Owner's Name S TMPT,FX(;RTNNELL Owner's Phone Number <br /> 813 1 626 115482 <br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name - I Titleholder Phone Number I I I 1 <br /> Fee Simple Address I <br /> - ni b,,-, .. 4 „.., ,- „,. -.-.4 [k`„,,,,,,. CZs^SF.PZ. ,r't, „,-..—..— +• .--- „,a,..,, „ £ -,.. 4,-;-, i . 3, , P ,,, `'' w .�.w'' - -v -,A ” , -X -? -- ,-4:6 *v`5 =`L kS✓v ` % ( ' `: w <br /> Job Address 2 2 3 1 t N i Y , i • ( t \, - c - L . O Lot # <br /> Sub Division Parcel # <br /> 1 ,#N .:i4%�.'t.`s�.- i ... ` .. .:::5'"�z€�, , ' ",.�2�'� =. �'�%✓ <br /> I • I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> f I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Controlled Bum Hood Installation <br /> I I Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale 1` <br /> I . I - Fire Protection Maintenance - ANNUAL • Places of Assembly-ANNUAL //i) <br /> IUtnyl ISemiI lAnI I tither 4 �f <br /> Sprinkler 1 1 ❑ ❑ ❑./ ( Recreational Burn <br /> Imo <br /> Fire Alarm ' ❑ ❑ Q� I 1 - I I <br /> Sparklers <br /> Hood Cleaning I I ❑ ❑ ❑ I 1 I I Sprinkler System Installations <br /> • Hood Suppression I I ❑ ❑ ❑ J 1 I I Standpipes (Sprinkler Sys) <br /> .• - . I. I Fire Alarm Installation <br /> Torch Roofing/Tar Kettle <br /> Fire Pumps <br /> ( - Waste lire Storage ANNUAL <br /> I I ' Fire Works <br /> I . I Flammable Application - ANNUAL I Valuation of Project <br /> f Fuel Tanks <br /> • <br /> I- Other <br /> Contractor / � cRw C/ <br /> is tered Y/ N <br /> Signature Re g J .0 <br /> Fee Current I• Y/ N I TrUSIZINISIMenleieenalnageStan <br /> ir <br /> Address `S Com t p ' I License # I <br /> ELECTR(CIAN - ' <br /> Company I <br /> Signature Registered Y / N , Fee Current I Y / N <br /> I ; <br /> Address 1 I License # I I <br /> PLUMBER I I Company <br /> Signature Registered Y / N 'I Fee Current - I Y / N" I <br /> Address 1 I License # . - I <br /> MECHANICAL' Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address I I License # I <br /> OTHER I Company I <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address <br /> License # <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 htt J/a <br /> ( p' ppraiser.pascogov.com) <br />