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- I0(2.7 <br /> 813 -780 -0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> Permit Application <br /> Date Received I 1 Phone Contact for Permit I 1 <br /> Owner's Name letiu'`r- J Y C 0 .1 \_ 3 4 ( (ifi I Owner's Phone Number I 1 1 1 1 <br /> Owner's Address [Po o u l L C t I A ' - - - P l c . : v l.EJb LI L L , ILL ?ti 17 - I L U <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address — 00 1 (1 'V CI , 4ti,. Ltll j* ':3�JL- 1 Lot# <br /> Sub Division Parcel # I J3 . ) S ' a 1 . LU it, • C41 • ail l j <br /> n Bio- Hazard Waste Storage - ANNUAL El Hazardous Material (Tier I! or RQ Facility) ANNUAL <br /> El Comm Exhaust Kitchen Hood /Duct Ii Hood Installation <br /> I Controlled Burn I-1 LP /Natural Gas - Installation <br /> I Emergency Generator < 30 kw I-1 LP /Natural Gas - ANNUAL Sale <br /> E Emergency Generator > 30 kw 71 Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL F Recreational Burn <br /> IQtrlyI ISemiI LW Other <br /> Sprinkler 7 ❑ ❑ IX n Sparklers <br /> Fire Alarm 0 ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ ( I 0 Standpipes (Sprinkler Sys) <br /> Hood Suppression l l ❑ ❑ ❑ I ( n Torch Roofing/Tar Kettle <br /> I Fire Alarm Installation I] Waste Tire Storage ANNUAL <br /> 17 Fire Pumps <br /> E Fire Works <br /> 1 Flammable Application- ANNUAL I I Valuation of Project <br /> ri Fuel Tanks <br /> 0 Other: I I <br /> Contractor � Company I I <br /> Signature ,G I Registered 1 Y / N I Fee Current I Y / N <br /> Address I License # ( I <br /> ELECTRICIAN Company I <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 I <br /> Address I I License # I <br /> OTHER � Company ice.. =\j c .-11 ' , lc y ':) <br /> Signature (/`� Registered ram Fee Current mei <br /> Address 3C (1( \.Q.. -v r`cJ�, l t.--- - z.Yy.FIgI License# l0dit4ts c) C)C19 LOA) 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 />