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813- 780 -0020 City of Zephyrhills Fire <br /> AO <br /> Fax -813- 780 -0021 <br /> .,)/741ftej Permit Application <br /> Date Received I Q (' <br /> ,/ - - ( I 8/3 11 217 I I `r�� 1 <br /> .... Phone Contact for Permit <br /> Owners Name [ PO n Clc �..L <br /> F S o - �fT Pi I l-es -reiC . ( Owner's Phone Number 1 / 3 1 1 782- - I 14C// 9 1 <br /> Owner's Address I 40 70 l , rid y ze p -1 r k t 1 tS ` PC. , Z <br /> / J <br /> Fee Simple Titleholder Name I I I 1 1 1 1 I <br /> Titleholder Phone Number l <br /> Fee Simple Titleholder Address I <br /> ` n <br /> Job Address I�-(„c>_O —� D(.1,1,�' -- Ci I-tl rk, 1l$ k- 3 - 35- `12-- J LL J I Lot # I I <br /> Kul <br /> Sub Division h f� t 11.5 Parcel # I 0 2 - 2 ( o - 2 1 — 0 0 . 0 - 0 <br /> n Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL 1 <br /> [ J Comm Exhaust Kitchen Hood /Duct El Hood Installation <br /> Controlled Bum a LP/Natural Gas - Installation <br /> 0 Emergency Generator < 30 kw LP /Natural Gas - ANNUAL Sale <br /> El Emergency Generator > 30 kw [J Places of Assembly- ANNUAL <br /> ® <br /> ::::: Maintenance - ANNUAL <br /> ::::: Bum 2 , ❑ ❑ ❑ <br /> b> 212 Fin; Alarm El ❑ I:1 0 I I n Sprinkler System Installation <br /> Hood Cleaning CI ❑ ❑ ❑ I I Ej Standpipes (Sprinkler Sys) <br /> Hood Suppression ❑ ❑ ❑ I I E Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> 0 Fire Pumps <br /> n Fire Works <br /> n Flammable Application- ANNUAL <br /> n Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor <br /> Signature :•••• ��, �� CV!. I Company f , Registered �comi Fee Current mug <br /> Address d .e SI e /2) .T t p FL 33 6 37I License # <br /> ELECTRICIAN' I <br /> Signature I Company I <br /> Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I <br /> I License # I <br /> PLUMBER <br /> Signature I Company I <br /> Registered Y / N I Fee Current I Y / N I <br /> Address I <br /> I License # <br /> MECHANICAL' I <br /> Company 1 <br /> Signature <br /> Registered Y / N I Fee Current I Y / N I <br /> Address <br /> I License # <br /> OTHER <br /> Signature I Company I <br /> Registered Y / N j Fee Current I Y / N I <br /> Address I <br /> I License # 1 <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 />