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813 - 780 -0020 City of.Zephyrhills Fire <br /> Permit Application Fax -813- 780 -0021 <br /> Date Received ) Z /0 <br /> Phone Contact for Permit <br /> Owner's Name 2 L -� Y ZCi 1,. -J��'\ 1 I 1 .....v ., <br /> Owners Phone Number <br /> Owner's Address I <br /> Fee Simple Titleholder Name I I ' I <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> (� eV 4 - S J <br /> ,3� V � Lot <br /> a.. <br /> Job Address ti33 I <br /> Sub Division I <br /> Parcel # <br /> ...... «_. c s..?..e-s :E4i4f .Q; x, ar"d.U4.. .§'M ,l'iVA sk' RNOMrz'r 'ifk. <br /> I I Bio- Hazard Waste Storage - ANNUAL " ` ` Y E° ' ' °.r <br /> r-, Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I Hood Installation <br /> Emergency Generator < 30 kw <br /> 1 <br /> LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I <br /> Places of Assembly - ANNUAL <br /> . Ma }Semis Other <br /> Sprinkler X <br /> �' ❑ ❑ Recreational Bum <br /> Fire Alarm ' ❑ ❑ ❑ I I 1 <br /> Sparklers <br /> Hood Cleaning 71 ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression f 1 ❑ ❑ ❑ 1 ( I ( Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 1 Valuation of Project <br /> Fuel Tanks <br /> I Other: <br /> Contractor �:: :,te �aza,.w�r. :ate ,....a <br /> M ti ta.,L' <br /> Signature I Company <br /> Registered Y / N - I Fee Current I Y / N <br /> Address 1 <br /> 1 License # <br /> ELECTRICIAN' <br /> Signature Company <br /> Registered Y/ N _I Fee Current I Y/ N 1 <br /> Address <br /> PLUMBER I License # <br /> Signature <br /> I I Company <br /> Registered Y / N Fee Current 1 Y / N 1 <br /> Address) I <br /> License # <br /> MECHANICAL <br /> Signature Company <br /> Registered Y / N j Fee Current 1 Y / N j <br /> Address 1 I <br /> License # <br /> OTHER <br /> Signature I Company <br /> 1 Registered Y / N Fee Current I Y / N 1 <br /> Address 1 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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />