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813-780-002o City of Zephyrhills Fire < rax -o i -r ov -w� i <br /> p/ Permit Application 1 . <br /> Date Receiv -d ► Matti r� i _ Phone Contact for Permit <br /> M ( i c Owner's Phone Number 1 13 1 hS v �' `{ U <br /> Owner's Name 1 L�!��C� 1t � �lJ`���J �1c.� 11 1. <br /> Owner's Address �5 \ ti�C:�r �� `) C' <br /> w ' 'NI- ' <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 I I , <br /> Fee Simple Titleholder Address I <br /> Job Address eD - \Glr tL < C r . Lot # <br /> Sub Division 1 Parcel # <br /> E Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> EJ Emergency Generator > 30 kw n LP/Natural Gas - ANNUAL Sale <br /> Q Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Mal Mal fia! Uther <br /> Sprinkler IMII i' ❑ ❑ n Recreational Burn <br /> Fire Alarm ❑ ❑ ❑ I I a Sparklers <br /> Hood Cleaning E=1 ❑ ❑ ❑ .I 1 a Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> En Fire Alarm Installation = Torch Roofing/Tar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ' Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor Company ' -' Y iZ . 'R- ,S <br /> Signature II Registered IrarAMI Fee eeCCurr rent Y / N <br /> NM <br /> Address ` 7 lC 1. C• , li l , ' t . , i (0 . License # Lga s <br /> ni ��- <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I '_ I License # I <br /> c'° .,:• . .. _ Il w Company <br /> PLUMBER s ■ <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I 1 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 1 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 (httpJ /appraiser.pascogov.com) <br />