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813- 780 -0020 City of Zephyrhills Fire 4 q ,,/ r3q Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I Phone Contact for Permit I W03 1 1 ZZ i-f I 1 11 S 51 <br /> Owner's Name 1 2E-Pt4 y l` 4-1.1V Eti 4e ( 7 -i 'V 7 r- " ' L Owner's Phone Number 1 a 1 3 ( 1 7 a Z I I SS id <br /> Owner's Address 13 T 4 0 2 S O ' 4 V 0 2G - 24 1 1 1 1 1=-1 . - 33.514 2 <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 1 1 <br /> Fee Simple Titleholder Address I .�^ <br /> Job Address - 3 O a SO 4 4 VE wv U C 2 E 1 #2. '1 f (' S e Y— I . 3 35 # I <br /> Sub Division I , n Parcel # <br /> Ej Bio- Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> El Controlled Burn I-1 LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> n Fire Protection Maintenance - ANNUAL n Recreational Burn ` /e''9Ne N // 4 / <br /> �Qtrlyl emi Oil Ma. SC 4.. of r/ /r v( <br /> Sprinkler D ❑ ❑ ❑ _ [ Sparklers <br /> Fire Alarm 0 ❑ ❑ ❑ I 1 LI Sprinkler System Installations 7//6 /G <br /> Hood Cleaning ® x ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I I n Torch Roofing/Tar Kettle <br /> Il Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> R Fire Pumps <br /> Fire Works <br /> El Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> Q Other: I I <br /> Contractor ; ��s Company ? i'�2E5SCAI ,L C UlLE i G . I <br /> � <br /> Signature � --' L Registered Y / N 1 Fee Current Y / N <br /> / <br /> Address I / 70 4 Lac. V %Sew r -s ./ L I License # ( I <br /> ELECTRICIAN / -Q /i9' N / �/ .. 33cfG Company <br /> Signature (� �l R !Y1 Registered Y / N I Fee Current I Y / N I <br /> Address ( I License # ( I <br /> PLUMBER Company I <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address I I License # ( I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # ( I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I 1 License # I <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 />