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. 4, q v <br /> igN <br /> � : <br /> City of ZephyrhillsFire • ` , <br /> s178D OD2D Permit Application �J Fax- 81:� -78D -0021 <br /> /'� - S <br /> T' Phone Contact for Permit , <br /> Date Received <br /> •� t ,_ -')L i - INN Owner's Phone Number 1 75:2, j 1 7€711' .2 Owner's Name ■ Owner's Address <br /> Titleholder Phone Number 1 1 <br /> 'Fee <br /> Simple Titleholder Name <br /> Fee Simple Titleholder Address! - a.,........_. ��" ._, . <br /> �� I�?'.. ,...��. vg �"+�"..afwnl'1,�" °'•�.x "a 1' - .. : -: <br /> ,.. ... .. -,� _, <br /> . <br /> Job Address AP . . Lot <br /> Parcel # I <br /> Sub Division <br /> Fumigation Tent <br /> 1 1 Sip-Hazard Waste Storage - ANNUAL 1 1 <br /> Hazardous Material (Tier r RQ Facility) ANNUAL <br /> 1 Comm Exhaust Kitchen Hood/Duct I I Hood installation <br /> n Controlled Bum � g ti/ <br /> LP /Natural Gas-In IIation __ <br /> Emergency Generator < 30 kw n LP /Natural Gas-AN AL Sale <br /> 1 Emergency Generator> 30 kw Li <br /> 1 1 Places of Assembly -A UAL <br /> Fire Protection Maintenance - A NNU yL ner <br /> Limy] lsemrl t - : 1 t tc l' f r r" t° i " <br /> / ' ` <br /> Sprinkler ❑ ❑ ID Recreational Bum e/ I i it — <br /> 1 1 1 1 Sparklers -' --- <br /> Fire Alarm <br /> FT 173 ❑ ❑ I 1 I Sprinkler System Installations <br /> r, <br /> Had Cleaning 1 <br /> E] ❑ ❑ ❑ Standpipes (Sprinkler Sys) <br /> Hood Suppression 1 <br /> :- 1 I Torch Roofing/Tar Kettle <br /> Fire Alarm Installation 1 Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> Valuation of Project <br /> 1 <br /> . 1 1 Fuel Tanks <br /> 1 Other: I <br /> Company . I <br /> Contractor Registered L Y / N I Fee Current I Y / N <br /> Signature , 17411 �r ����4: `6` 1 <br /> Address l 1,i rt,_, , Ma$;� I License# 1 <br /> ELECTRICIAN Company Registered Y/ N 1 Fee Current L Y/ N <br /> 1 <br /> Signature � 1 <br /> Address .1 License # <br /> Company <br /> • PLUMBER <br /> Registered Y / N 1 Fee Current L Y/ N <br /> Signature <br /> Address 1 1 License # 1 <br /> Company <br /> ME nature ALI [ . <br /> 11 Registered Y / N 1 Fee Current Y / N <br /> Signature 1 1 <br /> Address 1 1 •License # <br /> OTHER Company 1 <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address: 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, e 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 />