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,51$-. City of Zephyrhills Fire /q Z�� Fax -813- 780 -0021 <br /> Per it Application / <br /> Date Received 06 ®� Phone for Per 1-715-1.1.C1- <br /> Owner's Name f.—" 42L6 " Q T4 / vO��Ti Owner's Phone Number 2/3 S 9357 <br /> Owner's Address O MX 4 773S 3C� /- / a 2367*. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address Cell/A/7.4 W Ok / p2. ,ri G' L L . 7LVD Lot # <br /> Sub Division Parcel # <br /> ._, <br /> 7 Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum IT Hood Installation <br /> n Emergency Generator < 30 kw 1 I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I - I Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> Iutriy/ Semi( raj Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm TI ❑ ❑ ❑ I 1 I Sparklers <br /> Hood Cleaning 0 , ❑ ❑ 1 1 Sprinkler System Installations <br /> Hood Suppression 4 ❑ ❑ ❑ I 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I - I Fire Works <br /> H Flammable Application- ANNUAL 1 I Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> :'.e. "..*":'.ea`.�._..d:.a::ifN - CEAPA.., CUIN, :`=n.r aaal....:_102 ._t. & $'"",.vw..Mesae t_e,.. .L . , a. ,:;,: ' r.. � &:...msa..._ Y ; - <br /> Contractor Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address <br /> 1 License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current Y/ N I <br /> Address ( I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address I <br /> 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N . 1 Fee Current I Y/ N J <br /> Address I I License # <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current Y/ N I <br /> Address I l License # I <br /> Di rections: <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 />