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%13-78010020 City of.Zephyrhills Fire. If ffitrf 1 010 Fax - 81:-780 -0021 <br /> Pe it Application .. <br /> � /0 /0 /� / <br /> Date Received I V / P hone Contact for Permit %�j <br /> Owner's Name Z 0 --//04/47-1-/ Owner's Phone Number g /3 S <br /> Owner's Address P o. gV'` q73 7>1 /i / / F `- 3i7 <br /> Fee Simple Titleholder Name ` 1``s) Titleholder umber <br /> Fee Simple -fitieholderAddress I '1 l <br /> ,. <br /> Job Address ( / , DOk C.- OL E /ii/ 0/VC DOW TS' S Lot# <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL • _ - - • - <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum Hood Installation <br /> I I Emergency Generator < 30 kw - LP /Natural Gas - Installation <br /> ) I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL l I Places of Assembly- ANNUAL <br /> !(.ttrly! !berm] lAnl I tither <br /> Sprinkler n ❑ ❑ ❑ ( Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning { ❑ cr ❑ I 1 I I Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> I i Fire Alarm Installation n Torch Roofingffar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I Flammable Application- ANNUAL f I Valuation of Project <br /> I I Fuel Tanks <br /> n Other: I I <br /> Contractor / Company "' � �ii�r�7r1� <br /> Signature ,,.. -c c Registered Y / N Fee Current Y / N <br /> Address I I License # I I . <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y/ N j <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I 1 License # I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address License # I <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 />