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813-780 -0020 City of Zephyrhills Fire : ' / `litZ Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received j Phone Contact for Permit I SI 3 <br /> Owner's Name 3 h• Ci-C•11‘ R L �T4' / 11poy cock Owner's Phone Number S g3 17 g3 1 610_ j <br /> +..7 <br /> Owner's Address S -- c R 5it aaPhiyh; PPS F 2 335112- Q <br /> Fee Simple Titleholder Name Titleholder Phone Number 51 7 S3 C1 <br /> Fee Simple Titleholder Address <br /> tN <br /> Job Address 3e50g C'R 5 LI 2t_phy'r X 115 FL, .33 5 it Z-. Lot# <br /> Sub Division Parcel # <br /> .'S aFUNEs.. .z . R ..,+.:: ;: .ZM...ak `i;i...',' g:...d, +:urn'.. :72,4 .. ,._,:..,emu `W d.as .M.,:- ., ..w. ,,:1 .x.,._ <br /> I Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I] Hood fristallation <br /> I --- i Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale S•iwtc)11 Alni 12- PC <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> (utnyl Semi rA711 other <br /> Sprinkler I I ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 1 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation In Torch Roofing/Tar Kettle <br /> ^I Fire Pumps n Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> n Flammable Application- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> mo. ..x.:.. <br /> ....Q.. �. �, ° -agaza.�.�� >..�, a . � « Vie ya �. m: . iiimatg ...... ..w .s'. ,:k.._ -: <br /> Contractor ��/� jj��� Company <br /> Signature '- �' �"�A►r Registered Y / N I Fee Current I Y / N <br /> Address 6980 C fL g-t 2ephy y{,i) FL-3354Z- I License # <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y / N _I Fee Current I Y / N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I <br /> 1 License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <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 /> • <br />