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813 - 7 80-0020 City of Zephyrhills Fire Q 7 - Fax- 813- 780 -0021 <br /> Permit Application 1 1 1 / <br /> Date Received 1 Phone Contact for Permit J1 7 <br /> zu s. «a�aa . , . �9 • ,,. se: <br /> Owner's Name Pal (r Iy Owner's Phone Number 11 11 I <br /> Owner's Address lP 6 (5 (Q111 p/ UJ 29 - •' ' - ((( - -, - - - - - <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> .t, arr €rr rg r g 4 rHO .` . 6 Kr& m611.. `rear $ .. , . irrtI Mt/ em u, ' ',':1, r m aC r€6 ? .a alai dq; qg a erg .m¢ <br /> Job Address 6815 Gall Blvd, Hiway 301 North, Zephyrhills, FL 33541 Lot # <br /> Sub Division I Parcel # I I <br /> aN a., g„ .. MDW4� �1M,arfla , §P',0M MM . G£x:-TME!fiz<sa,1:MMEIMra �fi <br /> E Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> E Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Burn n Hood Installation <br /> E Emergency Generator < 30 kw = LP /Natural Gas - Installation <br /> In Emergency Generator > 30 kw n LP/Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> FRF71 MO ♦' • Other <br /> Sprinkler lK ❑ ❑ n Recreational Burn ______R ❑ ❑ n Sparklers <br /> H ood CTearnng ❑ ❑ n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> El Fire Works <br /> 0 Flammable Application- ANNUAL 1 I Valuation of Project <br /> Fuel Tanks <br /> 0 Other: 1 I <br /> Ste: _ - A - ga t o„4 .,, O ..M; ed E3k€ara;e t, ' [ ' , ' . , Fay£:@ l '€ .ts..'="1 a4,. € :M - :II:04 9MM NM , ,���e9�@ . vn;'9'1' &�;3;�9: �p W: ids UNIWs�. ea <br /> Contractor / / Registered . Company � Fee Current _ 2 � <br /> Signature � <br /> ,(/V Y / N Y / N <br /> Address I License # * 1 ' Z <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( 1 License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current [ 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 (http: / /appraiser.pascogov.com) <br />