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813 -780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received • 1 2. -' 4- to I Phone Contact for Permit ` I I 4 I I t4ar <br /> 3 <br /> Owners Name I K C T 5 M„3 44. PIT M I Owner's Phone Number I f' 3 ELJi rjf <br /> .Hers Address J 2) '(5 44.1s <br /> Fee Simple Titleholder Name I Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I r� <br /> Job Address 3 1 cJ1 14IS Lot # <br /> Sub Division I Parcel # I <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation { 01 " <br /> n Emergency Generator > 30 kw //JJ n LP /Natural Gas- ANNUAL Sale 1 <br /> EK Fire Protection Maintenance - ANNUAL /' /q is E Places of Assembly- ANNUAL 12,.-. <br /> Itmly)'Semi' t�is� ," 1 <br /> Sprinkler ❑ ❑ ❑ [] Recreational Bum n 0 <br /> Fire Alarm ❑ ❑ 1 1 n Sparklers <br /> ' <br /> V <br /> Hood Cleaning El ❑ ❑ ❑ I 1 n Sprinkler System Installations J �`�" <br /> Hood Suppression ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) 41-7/ , j <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle : / ( 5 <br /> n Fire Pumps n Waste Tire Storage ANNUAL /1 _.. "•�'" <br /> m . <br /> n Fire Works C/J �� � �� <br /> I Flammable Application- ANNUAL <br /> 1 I ' .. VaIU aT O IOnT Project -- <br /> I Fuel Tanks <br /> Q Other: I <br /> Contractor Company 'y _1 /r 6 <br /> Signature �Qk <br /> � Registered Fee Current Y / N <br /> Address I 117/ w, thGe f 477 ,(/z iVj ?' I I License # I}'400 f1g: <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N J <br /> Address I I License # ( • I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> OTHER Company <br /> Signature Registered Y/ N J Fee Current I Y/ N J <br /> Address I 1 License # I I <br /> Notimissilo <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 /> • <br />