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813- 780 -0020 City of Zephyrhills Fire 4'9 356 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Pemvt <br /> Owner's Name Ctv..e 2,A Pi O; A -t g R \f ^rte n R-4- Owner's Phone Number 1 I <br /> Owner's Address 3c A (he m'($4 GO Aci Le f r <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 3 i' G ° � 3. /'Jnne l,y s� we-ill-4"i .t""i 2e f), 2.k; Hs , r L .33 sAs6 Lot it S s <br /> Sub Division Parcel # <br /> . .. , :: ..d,:»" ;1,3 ANMiATMu, .,, 3dMZ/:. » c4'2i. *`»r, , 11.1 ,.=:.YRMWI3' MO`. ;...NWOM VAWMA VM1MKEMAN EM s;? T .A= M-MV. _ -Za M , ,".. MM :,:* Q, ,u r:*=:.u. a.,, ..OSA .: a:iip:' <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I I Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL 15R1 Places of Assembly- ANNUAL <br /> lUtrly1 ISemiI F"' Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I ( n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I ( n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ ( ( n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> ri Flammable Application- ANNUAL ( ( Valuation of Project <br /> n Fuel Tanks <br /> n Other: I I <br /> .....x1M" 1ica 43 ;• :1 -Aai' i 'S n.,.? aiVAg P ? ":ag-£. l, ,VzrA tafa€ ei s; ",'i:lZQE m& ,'M'JgKtS Mm ..:.... - Ngz: lWP . L;,..;/ kg 2.., z..s . r- .Z*•.°...X. §: s.... - Vszr g,arl:..maggk "Wi.1,. <br /> Contractor Company <br /> Signature ' ,C Registered Y / N I Fee Current I Y / N <br /> Address ,r "' <br /> I License* <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address ( I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I <br /> I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address 1 I License # 1 <br /> trz <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 />