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813a80 -0020 City of Zephyrhills Fire _N I Vi s -0021
<br /> Permit Application
<br /> Date Received J Phone Contact for Permit ( J 1 J 1
<br /> Owner's Name W /A) ( / 6) LC 1+014 C / A/e.t( 1 Owner's Phone Number ' 13 7Z � ` 1 IS
<br /> Owner's Address 3g09-?-- W) Al -ree b e._ f
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1 I
<br /> r_. . >...,alu M :- :,>i OMMM M IS....s..: `MMENV AMI' f'E,MOSW : ` SWW?°aa. '.4:`EaMIM:. s v, .?c -.., T . MME r.., , . ', R eg . ,N , u.,... , i' R' a s,. %.,a., , ? -...
<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> ,.z,f ::w '. , n NlR IAMx: ,a4V;1 -TrA 41:,,,: 'z!, I £ate+ XSIf dirialS :% Ga'* ,....,,; a�,,,..r,Lc..WaaM llMi'.,.. .., .. :". Ma ...;, ikAl:.. AW Fv ..'� -r 4..:a ,a .v,, a Y re,.... :uegM as' `�" "!
<br /> FT Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> Ti Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
<br /> lLttny) 'Semil rATTI 1 Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 1 1 Sparklers
<br /> Hood Cleaning E ❑ ❑ ❑ ( 1 n 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 n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 ( Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I I
<br /> «t....,x.. _ >_ ; ;»„E - , E...?al ASEKINP2sats ° tfs..c..a,, nignaM: -... x . t; r?' .AKSEM E 'r % : t,,; ._.. k R',4' is`g- +::.a .... ... l Ig.T.....w , faggi fRU,...r, _ : < ::*. aR .1.216, ;....
<br /> Contractor {� �� Company I
<br /> Signature /i�� VV Registered Y / N I Fee Current I Y / N j
<br /> Address I I License # I I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address 1 1 License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N 1
<br /> Address I I License #
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address 1 I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y / N
<br /> Address 1 License # 11 1
<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)
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