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813-780 -0(520 City of Zephyrhills Fire 0 / J c., Fax- 813 - 780 -0021 <br /> Permit Application : <br /> Date Received I 1 Phone Contact for Permit NEM I `'‘6 1 6 20 <br /> j <br /> Owner's Name .Sr f/04,1 Pori , � l 1'd V L L G Owner's Phone Number / <br /> Owner's Address ?/ L' /v / 'j ^ s f /i rzo,A. t)€kn o R. cko,o,id ,. V'. 232/f <br /> Fee Simple Titleholder Name N ill Titleholder Phone Number <br /> Fee Simple Titleholder Address I _ MI Ir <br /> Job Address 5 <br /> 7' ' ' ?-Ail %i ci zclitw/t i (1S Ft 33 /-? Lot# / - 7 <br /> Sub Division Cit o f Z e ?I, Hi7I S. Parcel # ii-," — 001O 0? QO(J -00( 0 <br /> / (OB PAINED FROM PROPER 1 Y TAX NO] ICE) <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> F - 1 Controlled Burn n Hood Installation <br /> I - 7 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> T7 E mergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> ler Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Sprinkler I Recreational Burn <br /> Fire Alarm tg I I Sparklers <br /> Hood Clean /Suppression i n Sprinkler System Installations <br /> T7 F ire Alarm Installation 1 I Standpipes (Sprinkler Sys) <br /> n F ire Pumps I I Torch Roofing <br /> I F ire Works n Waste Tire Storage ANNUAL <br /> n Flammable Application- ANNUAL <br /> Fl Fuel Tanks <br /> 1 I Valuation of Project <br /> n O ther: 1 <br /> Contractor 11 �( Company G . " "5 P4 1a' i"` C O z — <br /> Signature Registered WEN F ee Current m <br /> Address I 3/ s /3�e! c -r Sfti vie, / /fi l/ / ( 57 License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current I Y/ N - I <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address 1 <br /> I License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address I <br /> I 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. <br />