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Z13-780-0020 City of Zephyrhills'Fire. .....s. q9r, <br /> 0 <br /> Fax-813-780-0021 <br /> Permit Application <br /> Date Received L__._ <br /> Contact <br /> i f ___ <br /> Owner's Name STMPT,FX(313TN F,T,L — 1 ,flw flf ,r,iaw), Owners Phone Number 813 626 5482 <br /> Owners Address 4701 Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address I ® Sc3 GIL L11 %rr1. Ze 'tr h g OS L .35<-1 I Lot # <br /> Sub Division Parcel it <br /> I Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 1 1 Controlled Bum l Hood Installation <br /> I I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw 1 LP /Natural Gas - ANNUAL Sale <br /> 1 I' Fire Protection Maintenance - ANNUAL I Places of Assembly-ANNUAL <br /> I Utrly) JSemi ('Ani l Other <br /> Sprinkler KJ ❑ ❑ I I Recreational Burn <br /> Fire Alarm 1 1 ❑ ❑ - ( ( I I Sparklers <br /> Hood Cleaning f I ❑ ❑ ❑ I I I ( Sprinkler System Installations <br /> Hood Suppression 1 1 0 0 I I I J Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation 1 I Torch Roofing/Tar Kettle <br /> I Fire Pumps 1 I Waste Tire Storage ANNUAL <br /> I Fire Works , <br /> 1 Flammable Application- ANNUAL 1 ( Valuation of Project <br /> I Fuel Tanks <br /> I Other: <br /> Contractor f <br /> 1 Company 3 'v' C t( <br /> Signature Registered Y / N I Fee Current I. Y / N <br /> Address I License # I • I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N , 1 , Fee Current 1 . Y / N ; l <br /> Address I 1 License # I <br /> PLUMBER _ Company <br /> Signature Registered Y / N '1 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 1 1 License # I I <br /> OTHER Company . <br /> Signature Registered Y / N Fee Current I Y / N 1 <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 /> - <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:/fappraiser.pascogov.com) <br />