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J13780- )20 City of Zephyrhills Fire Fax - 813780 -0021 <br /> Permit Application <br /> Date Received ' - Phone Contact Permit a.,,. ,� . ` ` �""'`�mT:-ti._- �tz...6•a+a -:+.�; �_:... _. _ _ .. ,�. .U.� _. _. .ie - x- •.'- �z€rs..� . �. _ ..., <br /> ct or e <br /> -�— mo � . ..µ� <br /> Owner's Name u • . : l► Mall I INE MI iffl ME RA Owners Phone Number 813 , 626 5 4 8 2 <br /> V <br /> Owners Address 4701 Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholderAddress I <br /> Job Address DsV Vim, eh1rh,11S Vt SS`(I Lot# <br /> Sub Division Parcel # <br /> • I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> 1 1 Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I I Controlled Bum Hood Installation <br /> I I Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> - I I Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> J. I' Fire Protection Maintenance - ANNUAL - Places of Assembly - ANNUAL <br /> I A ' IAn! I Othe <br /> Sprinkler 0 ❑ I I Recreational Burn <br /> Fire Alarm I I ❑ ❑ ❑ I I I 1 Sparklers <br /> Hood Cleaning I I 0 ❑ ❑ I I I I Sprinkler System Installations <br /> • Hood Suppression I I ❑ ❑ 0 -. I I I I Standpipes (Sprinkler Sys) <br /> I . I Fire Alarm Installation . Torch Roofing/Tar Kettle <br /> I I Fire Pumps I ( Waste The Storage ANNUAL <br /> I I • Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> 1i Fuel Tanks <br /> r Other I <br /> Contractor � ����;��., /Fr de Company ri kg( K�rfs— LC <br /> Signature Registered _ Y / N Fee Current I' Y / N I <br /> Address ` I _.. License #. I • I <br /> ELECTRICIAN Company • ' <br /> Signature Registered Y / N , I Fee Current I Y / Ni ., <br /> Address I • I License # <br /> PLUMBER Com <br /> Signature Registered Y/ N 1 Fee Current I Y 1 N'` I <br /> Address I I License # • • I <br /> MECHANICAL Company <br /> Signature Registered L Y/ N 1 Fee Current I Y / N I <br /> Address I ( License # I I <br /> OTHER Company - <br /> Signature Registered L Y/ N I Fee Current 1 Y/ N 1 <br /> Address License # 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 />