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813- 780 -0020 City of Zephyrhills Fire <br /> Permit Application Fax -813- 780 -0021 <br /> Date Received , Phone Contact for Permit <br /> Owner's Name I F b &df -f - %cwch or 2 ,tu I i5 ( <br /> Owner's Phone Number I I1 I I <br /> Owner's Address I 3 5 9cW 5 / G-C._ <br /> Fee Simple Titleholder Name I I Titleholder Phone Number I 1 1 1 1 <br /> Fee Simple Titleholder Address I <br /> Job Address gI <br /> Sub Division I 1 Parcel # I Lott <br /> .v. ,..... .� v•. '^E.�'`"�i ..,.:.s - a «a.,,�,:wt xw .u.,:s:azM.:,...a., „ >,.e.. « <br /> I I Bio-Hazard Waste Storage - ANNUAL I ��� �� ° � <br /> Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material t <br /> r (Tier II or RQ Facility) ANNUAL <br /> Controlled Bu I� Hood Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw = LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL = Places of Assembly- ANNUAL <br /> Qtrly] !Semi' Mill Uther <br /> Sprinkler ❑ ❑ ❑ I Recreational Bum <br /> ire Alarm I ❑ ❑ X I I I Sparklers <br /> eaning I ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> I I Flammable Application- ANNUAL f <br /> Fuel Tanks <br /> 1 Valuation of Project <br /> n Other: I <br /> .., r k ,raRwm .a .+ :.teallen antrzfto <br /> "' 'aii..' a rp„wy, s';" , NeW.. =2zM 0m0:'a...A.,..c zr:sk'aR<'i.FM igWa?.M3acs„ "„. F;;<„s:, <br /> Contractor ir� / / �� / / /�� .: �_ — , ` . <br /> Signature f Company G LC6t��/�cEjr �l � ��(�( ��� <br /> Registered Y / N j Fee Current I Y / N I <br /> Address I <br /> License # <br /> ELECTRICIAN I Company <br /> Signature <br /> Registered Y / N j Fee Current I Y / N <br /> Address I <br /> I License # <br /> PLUMBER I I <br /> Company <br /> Signature <br /> Registered Y / N j Fee Current I Y / N j <br /> Address I I <br /> License # <br /> MECHANICAL <br /> Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N j <br /> Address I <br /> I License # <br /> OTHER <br /> Signature <br /> Company <br /> Registered Y/ N j Fee Current I Y/ N 1 <br /> Address I <br /> 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 (http: / /appraiser.pascogov.com) <br />