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813780 -0020 City of Zephyrhills Fire. J g3(f3 Fax -813 -780 -0021 <br /> Permit Application 1 <br /> Date I Ph one Co <br /> ntact for Permit <br /> Owner's Name S TMPLFX(;RINNELL Owner's Phone Number 813 626 5482 <br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name - Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> .. .' w *..A.n .r-- r- ' .: :,,, sue- -s '1, ,--.—... 4 .. -..ez "' • .v, _ <br /> Job Address 6 C — t a r l , V , i - , e _ \o? I ( 1 1 it 5X Lot# <br /> Sub Division Parcel # <br /> ' I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Burn Hood Installation <br /> I Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> . . I I Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> I <br /> 1 Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> I (Arly' I Semi I IAnI I Other <br /> Sprinkler I ❑ ❑ ❑ I I Recreational Burn e/Afairt <br /> Fire Alarm I Y /� CI ❑I ( Sparklers 15) 6? <br /> A <br /> Hood Cleaning I I 0 El El I I I I Sprinkler System Installations <br /> - Hood Suppression 1 I ❑ ❑ ❑ I 1 I L Standpipes (Sprinkler Sys) 03 <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works Fl pt.-feu 1 <br /> Flammable Application - ANNUAL �" S <br /> I I Valuation of Project <br /> �� <br /> I Fuel Tanks <br /> I Other: I <br /> dr ; , ���: =;,-,� �.��>� �•��; -max �,�, .�,;:;�.•��� ��.� � >�; -- .m�.��.s �;.�.�- <br /> Contractor <br /> Company 3 rer itei F t( <br /> Signature Registered Y / N Fee Current I Y / N I <br /> Address I `S <br /> ( License # <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y / N . j . Fee Current I Y / N : I <br /> Address I 1 License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N j Fee Current I Y / N I <br /> Address I I License # - I - I <br /> MECHANICAL Company <br /> Signature Registered Y/ N ] Fee Current I Y/ N I <br /> Address (. 1 License # <br /> OTHER Company - <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address Licensees# <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 />