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813- 780 -0020 City of Zephyrhills Fire 119 `r' [ 6 Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received l I Phone Contact for Permit <br /> Owner's Name ii.lP / /y/7'/J A22F Owner's Phone Number <br /> Owner's Address J A5 -444 A <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 378/.5 /3 ;If L , Lot # <br /> Sub Division Parcel # <br /> , � ,:; .. <br /> El Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct 1 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> (utnyl Semi) p k-r I tither <br /> Sprinkler n ❑ ❑ ❑ ` Recreational Bum <br /> Fire Alarm ® z ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 1 ( 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I 1 I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> FT Fire Pumps I I Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Ti Flammable Application- ANNUAL I I Valuation of Project <br /> FT Fuel Tanks <br /> n Other: I <br /> Contractor ✓ / Company � sd jp/ Ti <br /> Signature �/ IC 1 .� Registered Y / N 1 Fee Current Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current 1 Y / N j <br /> Address I I License # I i <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I I <br /> MECHANICAL Company I <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 Y/ N I <br /> Address 1 I 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 />