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813-780-0020 City of Zephyrhills Fire rax-o ' '-, au-ul14 <br /> - Permit Application . <br /> Date Received — - 1 Phone Contact for Permit L3 <br /> Owner's Name R,02-1 r (Yl C t IC-Pi C-4-1 r lc- I Owners Phone Number I e 3 1 1 16 1 �°j 1) to <br /> Owners Address 3[j 13j inAlQ-K./✓s r ss2 urk LL P*'( 214- I L s ) a.. 3 36 <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I , <br /> Fee Simple Titleholder Address <br /> I <br /> Job Address 3 0 1 3S 1 2.41 �a Z �hU_S ' -- 33 Lot # <br /> Sub Division Parcel # k 7 . • Z(. • Z.l' • 001 • 63900 • (bo 50 <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> a Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> 0 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Q Emergency Generator > 30 kw = LP /Natural Gas - ANNUAL Sale n // a <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL 4 / <br /> cm Vther <br /> Sprinkler <br /> mil p� ❑ ❑ n Recreational Bum <br /> n <br /> Fire Alarm ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ . l ( Q Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch RoofingiTar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL swam Valuation of Project <br /> Fuel Tanks <br /> Q Other: I I <br /> Contractor - Sot -'4 T• (P-4'- Company (2.0■ it . P(LxlML( -511.., "c.. <br /> Signature Registered / N I Fee Current 1 Y/ N <br /> Address 1 Z 1 /J • 1 fH ..s1 ` PM1 r p1 . 3N) S 1 License # I 4G, (j & 8 Z..00 oil SSC <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address 1 I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # I I <br /> ' MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N j <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <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 (httpJ /appraiser.pascogov.com) <br />