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813 -780 -002 <br /> City of.ZephyrhillsFire• 0354 Fax - 813 -780 -0021 <br /> l Permit Application <br /> Date Received I -- .-A S e. I my�m tar r aru <br /> Phone Contact for Permit <br /> Owner's Name 1 �. M v � ' <br /> t 1 S ' t e....1 1 4J t L Owner's Phone Number <br /> Q �{ " <br /> Owner's Address 1-3 -- z_.3 t / 1 r $ <,-. . 1 .. p.c. 'Of <br /> Titleholder Phone Number J <br /> Fee Simple Titleholder Name f <br /> Fee Simple 'Titleholder Address aE�: rt.„ w. _.,... <br /> Job Address <br /> �..w.,.t§m3rnaar. �.�, F.,..,. .,.. ,��x�°:tn;!. t #e . , a'w u c ,:. ... ..�.tr :.. ; <br /> .._ � „,. .. f Lot# <br /> '—.--- 2'3 v ( e-e sloes <br /> Parcel # <br /> Sub Division <br /> Fumigation Tent <br /> 1 Bto-Hazard Waste Storage - ANNUAL J <br /> Comm Exhaust Kitchen Hood /Duct 1 I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I - Controlled Bum 1 1 Hood installation <br /> 1 LP /Natural Gas - installation <br /> Emergency Generator < 30 kw <br /> Emergency 30 kw <br /> LP /Natural Gas - ANNUAL Sale <br /> P <br /> Fire Protection Maintenance ancc e - ANNUAL <br /> 1 1 Places of Assembly- ANNUAL <br /> 71 j trly1 lsemt1 rai lUtner 1 <br /> ,/ i • _ Sprinkler ❑ ❑ ❑ 1 Recreational Bum <br /> 1 I <br /> Fire Alarm ❑ ❑ 5( Sparklers <br /> _ <br /> Hood Cleaning <br /> ❑ ❑ ❑ I 1 1 Sprinkler System installations <br /> Hood Suppression _ ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys) <br /> 1 1 Fire Alarm installation 1 1 Torch Roofing/Tar Kettle <br /> _ 1 1 Fire Pumps 1 1 Waste Tire Storage ANNUAL <br /> 11 Fire Works <br /> I Flammable Application- ANNUAL Valuation of Project <br /> .1 1 Fuel Tanks <br /> 1 I Other: f -. w <br /> y s <br /> Contractor ' Company L./ 4 ( L !'.`e- . <br /> Signature � Registered Y/ N 1 Fee Current 1 Y / N <br /> Address _ I License # <br /> ELECTRICIAN Company <br /> • <br /> Signature , Registered <br /> ignature Registered _ Y / N Fee Current 1 Y / N <br /> Address 1 License # <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address , •License # 1 <br /> OTHER Company <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address _ v... .. eva ..:....: r , <br /> 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, 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 /> • <br />