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813 - 780 - 0020 City of Zephyrhills Fire 0(6° Fax - 813 - 780 - 0021 <br /> L Permit Application <br /> Date Received Phone Contact for Permit 71/ SS' ! q 777 7 <br /> . �, �a; b �...•, 4 a, a� t € „ , m .rte <br /> ! n <br /> ,0 <br /> Owner's Name 1 FI,D(�IpA G ASTaCFJ1l r'LIgOL UGy ASS'. I Owner's Phone Number 1813 17 g O 11 8 6 <br /> Owner's Address 1 9053 DA u 6" N rIRy Rt. Z.EPH YAI.►LLS a 13 S`l 1 I <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 I I <br /> Fee Simple Titleholder Address <br /> Job Address 1 37508 DAu6NrERy Ro ZEPHyRt411U-s FL 3'iSN / Lot# <br /> Sub Division IC try n c ZCPu Y Il 14 i u.S Parcel # O -16-2, 1 00)O OO l d0 -oo2 A 1 <br /> ri Bio- Hazard Waste Storage - ANNUAL I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> [I Comm Exhaust Kitchen Hood /Duct F Hood Installation <br /> ri Controlled Bum I LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw (l LP /Natural Gas - ANNUAL Sale <br /> I — I E mergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> I] Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> IZWI ISemiI Mil Other <br /> Sprinkler ® ❑ ❑ Ac , 0 Sparklers <br /> Fire Alarm El El ❑ ❑ I I n Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ ❑ I 1 ri Standpipes (Sprinkler Sys) <br /> Hood Suppression ri ❑ ❑ ❑ I 1 Ii Torch Roofing/Tar Kettle <br /> r i F ire Alarm Installation I Waste Tire Storage ANNUAL <br /> I — I F ire Pumps <br /> Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> Ii Fuel Tanks <br /> Q Ot r: I I <br /> 'i ,4, 44 , *' ,,,,,, - , ,4: •W' „ r.�; ` •14 -. 4441 z± eosg' °....ate _- . ; _ .. MMWMI4 ".'yW r,."S.; . Ka a..y0 ;, IA ea,.. , tier <br /> Contractor C. �+ Company ASAP ynt -fA7]6 S�LI4K�Fa -A0 Pte/ I <br /> Signature C-. o.ti.o,_ J ii 9 C, 1 A V 6 N Registered Y/ N 1 Fee Current Y/ N 1 <br /> Address Sj - 11sr• TER0.pcfr S'f LAar cp. 3 ? 1 I License# I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # ( I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> MECHANICAL Company I <br /> Signature Registered Y / N . 1 Fee Current I Y / N I <br /> Address I I License # ( I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I 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 />