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813 - 780 -0020 City of.Zephyrhills Fire - rax -o i o-i 01J I . <br /> 1 Permit Application _ . _ <br /> Date Received 4 — 1U , / Phone Contact for Permit <br /> Owner's Name KO Cb PRO - Pti1L n L3 I Owner's Phone Number 1 1 I I <br /> Owners Address 3b 6 DAve.,1-1--T 1LY R ZU YR. }hLC—S , Pr-• ,a 3514 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address ( tO13 - r1833 GI -- ir3c,Yd, / ` /6 ER Lot# <br /> Sub Division <br /> Bio-Hazard Waste Storage - ANNU <br /> AL a Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct F Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum ( 1 Hood Installation <br /> Emergency Generator < 30 kw ( LP /Natural Gas - Installation , <br /> Emergency Generator> 30 kw I LP /Natural Gas- ANNUAL,SaIe <br /> I—I Fire Protection Maintenance - ANNUAL I Places of Assembly - ANNUAL /1) / /4 / <br /> Utner <br /> Sprinkler El 7 ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning JJ ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> Fire Pumps 1 Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application - ANNUAL KAZ` -. oo I Valuation of Project <br /> Fuel Tanks <br /> Q Other: I I <br /> Contractor za T eAp. ZVs Company (Zpbpr P t 2.1Z ' e .S2) nx.u. S , /N.c • I <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address 1 7-N ? I N . 'tom" - 1 A A-, p .. 33(.) 5 I License # (t.11 (34 E3Z000) ISgg I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N _ Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N Fee Current I Y / N j <br /> Address I <br /> 1 License # I I <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y / N I <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 />