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8'13 - 780 -02,0 City ofZephyrhills "Fire. (O� O9 Fax - 813-780 -0021 <br /> - t�� � r7 Pe it Application <br /> I <br /> Date Received J / ( 0.2- /0 /0 Phone Contact for Permit <br /> .r.�. «.., .. ..... _ __ <br /> Owner's Name %-%.5.2-,2-- 0 -- / 1 7 10 4/79 - 7 - 7 1 / Owner's Phone Number 2 /3 STS - 3�7 <br /> Owner's Address '7: O OA' g73' t79 /1/39- FL 334' 7 <br /> Fee Simple Titleholder Name 0 (0 Titleholder Phone Number <br /> Fee Simple Titleholder Address /) 1 (0 <br /> Job Address C77'7 / . .7 Ok C 4- ! /OZ-E /V 0/1/C DOME Lot# } <br /> Sub Division Parcel # <br /> I Bio-Hazard Waste Storage - ANNUAL J i Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 1 1 Controlled Bum I I Hood Installation <br /> I Emergency Generator < 30 kw • I LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> Iutny1 Ibemm1 other <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 I ( Sparklers <br /> Hood Cleaning -4 ❑ 12 ❑ I I I Sprinkler System Installations <br /> Hood Suppression I 1 ❑ ❑ ❑ 1 I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> I 1 Fire Works <br /> I I Flammable Application- ANNUAL I -I Valuation of Project <br /> I Fuel Tanks <br /> 1 1 Other: I <br /> Contractor - Company b <br /> Signature air- Registered I Y / N j Fee Current I Y / N <br /> Address J License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current 1 Y/ N I <br /> Address 1 <br /> License* I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address J <br /> I License* <br /> MECHANICAL Company <br /> Signature Registered Y / N J Fee Current I Y / N j <br /> Address I 1 • License # <br /> OTHER • Company <br /> Signature Registered Y / N _I Fee Current 1 Y/ N 1 <br /> Address <br /> 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 l /appraiser.pascogov.com) <br /> • <br />