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813-780-0020 City of Zephyrhills -Fire. 1 6/ 41 q Fax- 813 -780 -0021 <br /> . Permit Application <br /> Date Received r 1 Phone Contact for Permit <br /> tr1�11 ► / tr �^ <br /> L - <br /> r <br /> Owner's Name S TMPT, ,XC;R NF,LL Y Mc. e J�-wl o Owner's Phone Number 813 626 5 4 8 2 4 <br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name - Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> r�r r <br /> Job Address 1 o Cici t t '6Vc '€ Phv e h a ! S T L 3364 1 Lot # <br /> Sub Division Parcel # <br /> F!" w.:g;, <s ::- .aura >e -,'-- as z$ w ;s - 4-- .., : , — ,„ -, ... r.a -:. ,M , ... , w, r: r. .®:3+1. . - <br /> • Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent . <br /> Comm Exhaust Kitchen Hood /Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 1 Controlled Bum 1 Hood Installation <br /> Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> . . I 1 Emergency Generator > 30 •kw 1 LP /Natural Gas - ANNUAL Sale <br /> I 1' Fire Protection Maintenance - ANNUAL 1 Places of Assembly - ANNUAL <br /> I Carry! 'Semi' IAnI1 Other <br /> Sprinkler I I ❑ ❑ ❑ I I Recreational Burn <br /> Fire Alarm 1 ❑ ❑ AS I I I I Sparklers <br /> Hood Cleaning I I ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ 1 I 1 I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation 1 1 Torch Roofing/Tar Kettle <br /> Fire Pumps • I Waste Tire Storage ANNUAL <br /> 1 1 Fire Works <br /> I Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> Other: <br /> I 1 <br /> ?S;`.�'"i�'"'r�et� �£�,��= 'c'�L AWE` 3 i✓ 6 �"' ' k. 3 s 4 C'.: ?%. e�::. � s�' m; �t4' ?� .. �° ki.. N4" m} 2T. bb:` r' kL> 4:,& �;=. Ai�w" 5' �- 2��`�;G,'s��'iW_ '°y+'. a�6kr6::i���m3,, ua'a may. ...^�'°rc�'95 <br /> Contractor Company 'v" 4 Kr.;.-....,c( <br /> Signature Registered Y / N I Fee .Current I' Y / N I <br /> Address I 1 _... License # ) - • I <br /> ELECTRICIAN Company <br /> Signature • Registered Y/ N I Fee Current I .. Y/ N 1 <br /> Address i I License # I 1 <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current Y / N I <br /> Address I I License # • ' 1 <br /> MECHANICAL Company <br /> Signature Registered Y/ N , Fee Current I Y/ N I <br /> Address 1. _ I License # 1 <br /> OTHER <br /> • Company <br /> Signature Registered Y/ N I Fee Current I Y / N . . <br /> Address License # <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 />