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, N o*e- : co e y o -c 1- P-e' 0. ; f ,a-PP it c..+ - o,.i w„a-s <br /> . Pr"eY6Dos ly .co-xed ot Mosfl,osY B /Zy /ni. <br /> • <br /> 813-780 -0020 City of Zephyrhills Fire qqb <br /> Fax -813 -780 -0021 <br /> Permit Application kg t� <br /> Date Received 8/2 • Phone Contact for Permit 3o I 1 .5q .5 I O 2 %?-3 <br /> Owner's Name F 2 . & :Wu u -- . N PC .rij t ij Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> 5 s I I <br /> C� <br /> Job Address J 8 6 y D Lot # <br /> Sub Division Parcel # <br /> I Bio- Hazard Waste Storage - ANNUAL Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct Hood Installation <br /> n Controlled Bum LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw LP /Natural Gas - ANNUAL Sale <br /> I I Emergency Generator> 30 kw Places of Assembly - ANNUAL <br /> n Fire Protection Maintenance - ANNUAL I Recreational Burn <br /> IQtrlyl I Semi I Other <br /> Sprinkler I ❑ ❑ ❑ I I Sparklers <br /> Fire Alarm 1 ❑ ❑ ❑ ( Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ Standpipes (Sprinkler Sys) <br /> Tpr• -h 0.,,-rnn � <br /> HoodSupprssiu _� 0 �� � '.,r i0 �rr e <br /> I Fire Alarm Installation I Waste Tire Storage ANNUAL <br /> I Fire Pumps <br /> I Fire Works <br /> I Flammable Application- ANNUAL I A/ /,Q I Valuation of Project <br /> I Fuel Tanks <br /> I Other: I I <br /> Contractor Company / j ,8A .�� <br /> Signature /� Registered (1')/ N I Fee Current ( Y / N I <br /> Address I'VAC A.) Lk) ' '2,/lb E NV Awl i , 0_, �317 I License# boi/3e os crt I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company • <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I License # I 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 52500, 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 />