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813-780 -0020 7 City of Zephyrhills Fire <br /> Permit Application Fax- 813 -780 -0021 <br /> + dGU / ' <br /> Date Received Mali Phone Contact for Permit <br /> 1� •r.,� <br /> Owners Name 1 _ I..fa _ Ze�h��t'l l l Inl 1 ( fB 1 I �5 <br /> �� . ` j i Owners Phone Number Q 1 X, <br /> Owners Address I2y2 e\A I('i ) , t` 14CICtY� fl 3j t P )' I <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address Ian y U E.1IC1c1C\ BI V� 7� 1' h - 2,9-,f. -- 31-1 \ ►� �s Ti 'i 2_ , I Lot # I I <br /> Sub Division I 1-i I Parcel # b3 2tp -Zi - C:\0 7 cIf <br /> , ,.... ... ,*,.:¢ ,� •:s � 'B+¢, �.�,� �°.r #'v ^,`roar krtn;w r,. �.,,� „. <br /> II Bio -Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> E Comm Exhaust Kitchen Hood /Duct = Hood Installation <br /> Controlled Bum = LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw = LP /Natural Gas - ANNUAL Sale j' <br /> Emergency Generator > 30 kw Places of Assembly - ANNUAL,. - //� sL f <br /> ® Fire Protection Maintenance - ANNUAL Recreational Burn - J <br /> fQNU•„i l loll m maim j � <br /> Sprinkler 1=1 ❑ ❑ ❑ n Sparklers <br /> Fire Alarm E ❑ ❑ ( I n Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ ( I n Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> 0 Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> 0 Other: 1 <br /> = s w <br /> Contractor LI[Ji��►rrlf�Yl l_St� <br /> i e 1 1 , /P Registered ream rIhif F N� <br /> Address / 01 . • - i, . 4 - St -' t D License # I E/ [ ) /pf — 7 <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y / N,I <br /> Address License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I <br /> I License # I <br /> I <br /> OTHER Company I <br /> Signature Registered Y/ N I 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 (http: / /appraiser.pascogov.com) <br />