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813 -780 -0020 ' City of Zephyrhills Fire 1 ?c, Fax- 813- 780 -0021 <br /> - Permit Application <br /> Date Received I I Phone Contact for Permit I 1 1 11 <br /> Owner's Name 1 .1 n - “1.64 - c,(1-E'ec Pc Se 5 1 Owner's Phone Number 1 0 p 1 3 I I Z (c LI 1 1 2,2t4L 1 <br /> Owner's Address 1 6c13 (,6-11 iol�Cl e ( kl I , FL- 335`1 Z <br /> Fee Simple Titleholder Name I Titleholder Phone Number I 1 1 <br /> Fee Simple Titleholder Address I I <br /> Job Address 1 b 3 5 (96,.11 oc..cl � e o k c h e 11 s r t- 3 3 59 z Lot # <br /> Sub Division I Parcel # I I <br /> El Bio- Hazard Waste Storage - ANNUAL El Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood /Duct El Hood Installation <br /> El Controlled Burn El LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> h <br /> H, <br /> Emergency Generator > 30 kw 5C Assembly <br /> -ANNUAL l o <br /> Fire Protection Maintenance - ANNUAL ell "`Z 1l 1 Pl aces of Assembl <br /> Recreational Burn <br /> ry !Semi' 1:Lll Other <br /> Sprinkler El ❑ ❑ ❑ Ei Sparklers <br /> Fire Alarm CI ❑ ❑ ❑ I 1 0 Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Hood Suppression ❑ ❑ ❑ I 1 n Torch Roofing/Tar Kettle <br /> LJ Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> El Fire Pumps <br /> 7 Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> Q _Othher: 1 I <br /> Contractor <br /> /CA) Company 1 e e+rc r� : e 5Se c u' • 5 5 4 W+ s ,Snc Signature , ... --- Registered UM/ Fee Current Ill N --) - ---- <br /> Address ($' I 0 0 - 6 .1t- (fl Lbf1 ii ) I i c-c , , FL- Y310 I License # I Er 00 0001d-1u <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y/ N <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> OTHER Company I <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 (http: / /appraiser.pascogov.com) <br />