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813 - 80 -0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name IP .I, /� � ' � r • L? J .; 4- -� � ' T'7� � Owner's Phone Number 13/ 3 117821156/31 <br /> Owners Address 3 7d A ,C� <br /> ©�, Jc � �J- ""/� • I <br /> Fee Simple Titleholder Name / Titleholder Phone Number O / 1 ( 7 e9 15 <br /> Fee Simple Titleholder Address I I <br /> Job Address ( a . , � I Lot# <br /> Sub Division I Parcel # v5 a/ A' 461410 w" <br /> El Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood /Duct In Hood Installation ` L / <br /> Il <br /> Controlled Burn n LP /Natural Gas - Installation i ^ 9.-000 649Z: <br /> n Emergency Generator < 30 kw ® LP /Natural Gas - ANNUAL Sale <br /> J Emergency Generator > 30 kw n Places of Assembly- ANNUAL / �^ <br /> E Fire Protection Maintenance - ANNUAL n Recreational Burn L r / £4..$ 0 )'' <br /> pi r y emT " ' I Other <br /> Sprinkler n ❑ ❑ ❑ n Sparklers <br /> Fire Alarm 0 ❑ ❑ ❑ I 1 D Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> Hood Suppression E ❑ ❑ ❑ 1 1 11 Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation In Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> 0 Fire Works <br /> 0 Flammable Application- ANNUAL I I Valuation of Project <br /> El Fuel Tanks <br /> Q Other: I I <br /> Contractor Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N ] Fee Current I Y / N <br /> Address 1 I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address I I License # <br /> OTHER / ,•,_ _ p A ,._ {— ' C- „ZVC: <br /> Signature Registered lQ all Fee Current Y / N <br /> • - License # r <br /> Address �{�•; �;. !., <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 />