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813-780 -0020 City of Zephyrhills Fire. � 3/ 7 Fax- 813- 780 -0021 <br /> Permit Application 7 _ _ <br /> Date Received , - Z. - do - F. 1 e Z <br /> P hone Contact for Permit <br /> r �37t t rx s� ;? + eE 446 644 :; M.. , s . ?cas ^nz•.., d r+,a _> _ .. � � a / - - __ ._ •qtr �-. -__ - _ _ ..�a+�. .. '+�a. -�,a�� ,:W,. aw,:.ck...>. <br /> Owner's Name 1 I L(„S L I Owner's Phone Number I 1 <br /> Owner's Address 12. ,ei-t.4 D j NTh <br /> Fee Simple Titleholder Name poil Vtc Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> if -4( <br /> Job Address 12M L o " 'Nis a , Y b. T o x o n ie.4) S A e Lot# <br /> Sub Division Parcel # <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 /> El Controlled Bum n Hood Installation <br /> ID Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Mg (Semis (i1 Vther <br /> Sprinkler ❑ ❑ n Recreational Bum <br /> Fire Alarrn n ❑ ❑ ❑ I 1 Ei Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression E ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> E Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 ( Valuation of Project <br /> Fuel Tanks <br /> Q Other: I I <br /> Contractor Company ,.,► r , r - �• !_ — _ _ ' <br /> Signature 7��- Registered � � 1 ry , Fee Cuurrre Y / N <br /> Address `'L ___ : _ _ r t ■ ism License# Llly'li' �'_►I.��t(Yi;rmi <br /> ELECTRICIAN � ��� Company IEN <br /> Signature r IM �' Registered Y/ N 1 Fee Current I Y/ N <br /> Address r 1 License # <br /> PLUMBER Company <br /> Signature Registered _ Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N 1 Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <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, 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 />