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813 -780 -002, - City of.ZephyrhillsFire. Fax - 813-780 -0021 <br /> Permit Application I CV(CrN X 3145 <br /> Date Received rm t 21 <br /> Phone Contact for Permit ,� L45 <br /> ti <br /> tWb <br /> Owner's Name Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> i_�o_�nky+.`. k+�w'q'b ,45N ?9s. 6'Sx.�'. , m,.. ..F:� ,.,,, ao. Ti.. _ ..:. - ...., sL�'...:. aY'`a - ..s....� -. nn.., x?3+d �' nai. ._.. 'rm^_,.v� 'max 1..k,.x : `.3.'3.3. *: <br /> Job Address • \ lb, • 1 , L 1' 1 AR I Lot <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - 'ANNUAL I I Fumigation Tent • <br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> - Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 1tdtny1 15emi1 tither <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm ■ ❑ ❑ ■ f I 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression n 0 ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ` ( Valuation of Project <br /> Fuel Tanks <br /> I 1 Othe Company • • r K { • Signature Dili Registered Komi Fee Current Iffiall <br /> Address I ' 1 License # I E F O!X)O 1 R5 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current 1 Y / N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address I License # I <br /> MECHANICAL Company <br /> Signature . Registered Y/ N j Fee Current 1 Y / N j <br /> Address 1 I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y / N <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 />