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813-780-0020 City of Zephyrhills Fire. .1 ( O b Fax-313-780-0021 <br /> Permit Application <br /> Date Received '.. Phone Contact for Permit <br /> t.-7,1,—...- -..,__ .,_..,-- - 1.,..<1•7 ----,...--,-,. ----..,--..,----- ..' -,-, .--.. -:.t --r, <br /> Owner's Name S TMPLEXGRINNELL Owner's Phone Number 813 1 626 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 <br /> - <br /> Job Address S(62:3?) "Dauci in 1 ,--C_J `-1 - 2- Q....,90,1 IP h t I I S V L 33 5q 1 Lot # <br /> Sub Division Parcel # <br /> .•" ....--, ,AMMatiAaar -,:----'. -,,,.- _ -- ...,,,4 ,...- <br /> I 1 Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood/Duct Hazardous Material (Tier It or RQ Facility) ANNUAL <br /> 1 . Controlled Bum I Hood Installation <br /> • I Emergency < 30 kw 1 LP/Natural Gas-Installation <br /> . . I Emergency Generator > 30 kw I LP/Natural Gas-ANNUAL Sale <br /> I. 1" Fire Protection Maintenance - ANNUAL • 1 Places of Assembly-ANNUAL <br /> 4 Lit:il 'Semi' IAni I tither <br /> sprinkler ' o o 1 Recreational Burn <br /> , Fire Alarm 1 1 CI 0 0 L 1 I Sparklers <br /> • ' Hood Cleaning 1 0 0 0 1 I 1 Sprinkler System Installations <br /> - Hood Suppression J 0 . 0 1 1 1 Standpipes (Sprinkler Sys) - <br /> - . I ' Fire Alarm Installation " - - 1 - Torch Roofing/Tar Kettle <br /> I Fire Pumps - Waste Tire Storage ANNUAL <br /> 1 Fire Works • <br /> 1 Flammable Application- ANNUAL 1 I Valuation of Project <br /> Fuel Tanks <br /> • , <br /> - I Other: I • • <br /> ,-d <br /> Contractor ' Alr dr Company " ri'll ie-, Ks,-... C( <br /> Signature ' Registered Y / N Fee Current I. Y / N I <br /> Address J License # . <br /> ELECTRICIAN Company <br /> Signature • ' ' Registered Y / N - ..I Fee Current Y / N <br /> Address I .. • I License # <br /> PLUMBER - . Company <br /> - , <br /> Signature Registered Y / N ] Fee Cun 1 Y 1 Ni 1 <br /> Address 1 - <br /> I License # - • I <br /> MECHANICAL Company <br /> Signature Registered Y / N J Fee Current 1 Y / N <br /> Address 1. <br /> I License # <br /> OTHER . - Company . . . <br /> Signature Registered Y / N I Fee Current 1 Y / N i <br /> Address License # <br /> Directions: <br /> Fill out application completely. - <br /> _ <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 /> - <br /> - Supply two (2) sets of drawings with applicable documentation .. . <br /> . . Allow 10-14 days for review after submittal date. Parcel # - obtained from m Property Tax Notice (http://appraiser. pascogov.com) <br /> . _ <br /> • <br />