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813-780 -0020 City of Zephyrhills Fire <br /> Fax- 813- 780 -0021 <br /> Permit Application <br /> Date Received , Phone Contact for Permit <br /> Owner's Name ....... „ . <br /> y ,'7' e/ / S /2p _r9 444 `Z 7 I Owners Phone Number I . I I I , ... F...- .., <br /> Owner's Address f " -- 1 - d c/ 5 0 1 <br /> Fee Simple Titleholder Name Titleholder Phone Number I I I I I <br /> Fee Simple Titleholder Address 1 <br /> . Ms .raraeMi amt .'+�s ,. aTa a^ mw. .... �tk: r,�, s..,ta .., <br /> Job Address Lot# �I <br /> Sub Division Parcel # I <br /> ;s.,.. i caMir l nwlimai a?S.+at.on i 3R d 1 .r7:,: : - X _ ,: F;. . ,,, e:, , ,W,,,,,+.i :w �z ::;g ' A iargaV W ,V.44;1,14,,,,a4144, 4s 144,5Jz 4 .+p; 4= a,;, r s Z ' '. <br /> I Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> 1 Comm Exhaust Kitchen Hood /Duct 1 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum n <br /> Hood Installation <br /> 1 1 Emergency Generator < 30 kw n <br /> LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw 1 1 LP /Natural Gas - ANNUAL Sale <br /> 1 -j Fire Protection Maintenance - ANNUAL 1 1 Places of Assembly- ANNUAL <br /> I(ltriy1 ;Semi! ricilq I Uther <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 I Sparklers <br /> Hood Cleaning n 0 ❑ I 1 Sprinkler System Installations <br /> Hood Suppression ' / ❑ Lq' ❑ I 1 Standpipes (Sprinkler Sys) <br /> 1 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> 1 Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> 7 Flammable Application- ANNUAL I Valuation of Project <br /> 1 1 Fuel Tanks <br /> n Other: 1 <br /> ,;tsR" t '�: : x?o ,,44,21•. s. 3:-: � .e�`° Yt:. mafti' `4vegz,'�,»% iQac . n N ,.. ? <br /> Contractor C `'t <br /> /7� -'" / ' <br /> Company 1 <br /> Signature Registered Y/ N Fee Current 1 Y/ N <br /> Address 1 1 License # I 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N J Fee Current 1 Y / N 1 <br /> Address 1 License* 1 <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current 1 Y / N 1 <br /> Address 1 1 License # 1 1 <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current 1 Y/ N I <br /> Address 1 1 License # 1 <br /> OTHER Company <br /> Signature Registered Y / N 1 Fee Current 1 Y / N <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 />