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• <br /> 813- 780 -0020 City of Zephyrhills Fire 26 Fax- 813 -780 -0021 <br /> /,F^ <br /> Permit Application '( <br /> Date Received Ci – / 7-0 7 1 ) ' / Phone Contact for Permit ? 72 7 1 1 2/ s 1 38 ?S <br /> Owner's Name 1 AL_L -- f eCI A/I - P ./Cik K Liib.N I Owner's Phone Number 1.7 S I Hs&'7 11 99o5 <br /> Owner's Address 381 76 1 " 6 Alit::: • 9- EP -iit7/ /Lt5 f i 935 <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address I {� � n , I I I <br /> Job Address 38 1 41 163: Av E . Z. Pt-r ykk /U. / Ft. 6 3 � � Lot # <br /> Sub Division I Parcel # I <br /> Bio- Hazard Waste Storage - ANNUAL ( Hazardous Material (Tier II or RO Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Burn I 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 <br /> (Qtrly) ISemiI (' Other <br /> Sprinkler Ei ❑ ❑ ❑ n Sparklers <br /> Fire Alarm El ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ ( 1 n Standpipes (Sprinkler Sys) <br /> ti Hood Suppression Ei ❑ ❑ ❑ I I n Torch Roofing /Tar Kettle <br /> Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> EJ Fire Works <br /> I Flammable Application- ANNUAL LI B' 00 I Valuation of Project <br /> II I ' Fuel Tanks � o <br /> n Other: I <br /> Contractor Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I I License # <br /> ELECTRICIAN Company lA.A. S - ACV4, I <br /> Signature / Registered Y/ N J Fee Current I Y / N I <br /> Address ( / 2. /eomrtlntt� /odic j'p, te r• M'2, PL1 License # ( eV_ ci9 j ( <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # ( I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # I 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 />