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813 -780 -0020 City of Zephyrhills Fire Fax - 813- 780 -0021 <br /> Permit Application cs <br /> Date Received l s B —.24,14) 1 Phone Contact for Permit I g6 3 116/L 1 1 74/ 7 I <br /> Owners Name f ■) L1,1 q...4";)- 1 Owner's Phone Number I 53 1 l 1 1 I <br /> Owners Address 13E? 56 ( E- At 2-2P �C / l <br /> 1 <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 1 1 1 I <br /> Fee Simple Titleholder Address I I <br /> Job Address 30 5221 =_-Az,, Lot # <br /> Sub Division Parcel # <br /> El Bio-Hazard Waste Storage - ANNUAL ED Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> E Comm Exhaust Kitchen Hood/Duct a Hood Installation <br /> E3 Controlled Bum El LP/Natural Gas - Installation i' <br /> A Emergency Generator < 30 kw LP /Natural Gas ANNUAL Sale © 0 <br /> F mergency Generator > 30 kw a Places of Assembly-ANNUAL - ANNUAL Al <br /> ire Protection Maintenance - ANNUAL 0 Recreational Bum f <br /> ® LI <br /> Sprinkler ❑ r Sparklers <br /> Fire Alarm ❑ ❑ El Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ I I El Standpipes ( Sprinkler Sys) <br /> Hood Suppression El ❑ ❑ ❑ I E=I Torch Roofing/Tar Kettle <br /> Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Woks <br /> Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> 0 Other. I I <br /> Contractor (‘ Company I <br /> Signature 7 Zi c 4_ Registered I Y/ N I Fee Current I Y / N I <br /> Address �4 A���� t9 License # ( I <br /> ELECTRICIAN Company A /, <br /> Signature ` � '/ So <br /> n9 Registered �Qj'� Fee Current Y / N <br /> Address p _ IF llirjY ���11:0 License # ( EFocx.V. U3 I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I License it I <br /> MECHANICAL C I <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address I I Licer -- <br /> OTHER �� <br /> ,‘...L 1 <br /> Signature Regi: 'ic • - <br /> Address I I Liken <br /> Directions: TU,(K ee ° )6P-Tit, <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with own i-; ,Z/' �f- <br /> �� ,i �` p <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) �J / <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Prc 0 . <br /> /7 <br /> yi& 17 ?/ 0 <br /> 969/t; ./(0, ril <br /> l V r ' .....:2'_____,....0-0----- <br />