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813780 -0020 City of Zephyrhills'Fire. 1 (100 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received <br /> _-,� :�.� �� � �`� „„ _ �_ � >�fi .te - for . ._,..� = � ��.� �� .m: <br /> Phone Co P erms <br /> Owners Name STMPT,F,XGRTNNELL Owners Phone Number 813 626 5482 <br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610 . <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> ,1...5 c3' - .-, _ : -. 1..: = °'.. ::-. 2. , „1 -.:ce A f �A'''.-^ ,:; °... «: ..:.,.., ...,, .. - <br /> ' a ll ” -.. _..zt a..<_... ,'�.w_ ..tee. " ii.. ...� '-, ".. <br /> CG Job Address 6(67 `1) a.cf`I /2 , 1. • 2. QVIAN(h 1115 'L J35y2' Lot# <br /> Sub Division Parcel # <br /> -„ -�_45e e P < , ,..- .,, , - , ° -�: = ,? ,rte - — -- . a 3 < ^= 7 --- . x .. - -. :-,,,,.---v--.. -- <br /> I Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I . Controlled Bum I Hood Installation <br /> I I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> • I_ I Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> 1. I' • Fire Protection Maintenance - ANNUAL I Places of Assembly-ANNUAL <br /> lUtrIyl !Semi' jAnl1 tither <br /> Sprinkler � - V y � ❑ ❑ V I I Recreational Burn <br /> Fire Alarm I ❑ ❑ ❑• 1 1 1 I Sparklers <br /> Hood Cleaning I O ❑ ❑ I I I ( Sprinkler System Installations <br /> • Hood Suppression ... I O t1 , -❑ I 1 I I _ Standpipes (Sprinkler Sys) <br /> 1 I._ Fire Alarm Installation - <br /> I I Torch Roofing/Tar Kettle - <br /> I • I Fire Pumps ( Waste Tire Storage ANNUAL <br /> I I Fire Works , <br /> Flammable Application- ANNUAL ( 1 Valuation of Project <br /> •` I I Flam <br /> Fuel Tanks <br /> ,� .Other: I ac>,c i'\UL.A.) • <br /> Contractor Company 3 Y <br /> � � Frt t( <br /> Signature Registered Y/ N I � Fee Current I. Y/ N I <br /> Address I I . License # I . <br /> ELECTRICIAN ;.- • •. _. , Company . <br /> Signature - ' . - Registered Y/ N I Fee Current I Y/ N : I . <br /> Address 1 , , <br /> 1 License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N ' I Fee Current' I Y / N; I <br /> Address I I License # - I ' I <br /> MECHANICAL Company <br /> Signature Registered L Y/ N I Fee Current I Y / N j <br /> . Address I .:.. I License # I I <br /> • <br /> OTHER Company - - <br /> Signature Registered Y/ N I Fee Current 1 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.(Mechanieal work over $5000) . <br /> - Supply two (2) sets of drawings with applicable documentation <br /> - Allow10- 14,days for review after submittal date. Parcel #- obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />