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813- 780 -0020 City of Zephyrhills Fire. Z 3 Fax -813- 780-0021 <br /> Permit Application 3 <br /> Date Received I p 2 -/J e /O <br /> Phone Contact for Permit =NM if 7S-- <br /> Owner's Name I I Owner's Phone Number I I I <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address rOrt L /c= 7' 7 6) s� 6 z-di (3/+-'d <br /> Lot # <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL r ,..V..... <br /> fowl ISemiJ Other <br /> i t <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum C �- � l <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers '�Q, O p 5 7 <br /> Hood Cleaning IT ❑ ❑ ❑ I I I I Sprinkler System Installations ` <br /> • <br /> Hood Suppression 1I ❑ S ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I I � Fire Works <br /> r� Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> I Fuel Tanks <br /> n Other: I <br /> 'r..�✓+,-s:< .FSi3'Y.>5ffi31 3/t'$",.`w ^..te - ;• §,.'4.33334/ 'dE,`!E �',VF � /�I� � 2':� 7 34 «'w:R S: 'i::.'; ...31.4"x...' e,. .m .. e<.:. .�_,°rY -sr...:&`. ..z.:. ._n °Sa. S_. :, ,. '"."t's, : ...,7 :. 6.:re. .r k <. c:.ff .t.s.err , x'444 .. ... a.., -s ,., r »,. r:_ . . <br /> Contractor �7.2 Company m ac - pt..54- - er pcvi -c - 1-er— I <br /> Signature <br /> Registered Y/ N I Fee Current I Y/ N I <br /> Address I L17ci Dc 1 r j - I lv - - 7G _ ‘ I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N,I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <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: / /appraiser.pascogov.com) <br />