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813 -780 -0020 City of.Zephyrhills Fire <br /> Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received <br /> g . /&"/ zn •„ Contactfor Penn <br /> Phone 1 <br /> Owner's Name /1.16 AIUneG Owner's Phone Number 32r 77V <br /> Owner's Address l 7A 2/ G,g // ���J <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address <br /> ' _ .... vl' ,`.iais" e w ... . ,.,saw.. n .^ ._.,..,.:, , . ,.. ...> "`�'w�,�.,'m ��dii.E.tC''�Ynw'� " i�`3M2`2 1t'�" ,....`.A, <br /> Job Address d <br /> Lot # f <br /> Sub Division <br /> athx a- a u, „: Parcel Pa * <br /> Bio Hazard W ..,••� �,z -�-�- �r� .,.. . , T aa.�"7 - <br /> aste Storage - ANNUAL I 1 Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct 1 I Hazardous Material (Tier II or RQ i ity) ANNUAL <br /> n Controlled Bum I I Hood Installation j <br /> n Emergency Generator < 30 kw n LP /Natural Gas- Installatio i'°/ 1 <br /> Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL ale <br /> C Fin= Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL _,.. ... <br /> . ID El ISemi In Other /'/ �/ �' �� <br /> Sprinkler ❑ n Recreational Bum ,, ” " f <br /> Fire Alarm n ID ❑ I I 1 Sparklers &K l' r <br /> Hood Cleaning n ❑ ❑ ❑ 1 1 1 Sprinkler System Installations f \ <br /> Hood Suppression X ❑ � Y <br /> �C ❑ 1 I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle , <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> I Fuel Tanks <br /> Other: <br /> rv.�. �:.. ..n. ":'fir t ekS wa:;r..::s ,fi'AP_esc - :'>:n - 5.,.r!'..'_•.2:.:2 •:i' -. ^ �b4+:z4+.»'»:4�P.: �...�%.:etim.=rM:ss ,FM+•adrM*"it'W$'Y v:.. <br /> Contractor Company <br /> Signature • Registered Y / N _ Fee Current I Y / N J <br /> Address I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N 1 Fee Current I Y/ N i <br /> Address 1 License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y / N 1 Fee Current 1 Y/ N <br /> Address 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N _ Fee Current Y / N <br /> Address I ��j? I License# <br /> OTHER , Co � ,,2CJ,( / h 6 C e) Company <br /> Signature , <br /> i ri Registered 6Y) N I Fee Current i N <br /> , l' � <br /> Address � s =���� iieLIMI �I�� License # rEj� 1:#701:1 MIII <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 />