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813- 780 -0020 City of.Zephyrhills Fire <br /> s Permit Application Fax- 813 - 780 -0021 <br /> Date Received 1 °g�� w <br /> Received •�• = I Phone Contact for Permit <br /> Owner's Name V 1`= / R igg -ST <br /> ,/l /PGH I Own er's Ph <br /> t�f'� � one Number <br /> Owner's Address �S'g.3/ 3 ' 4y-1 J <br /> Fee Simple Titleholder Name I I <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> r sssAt <br /> Job •, =t., .., ,.� .. N . �. ,� ��.a , <br /> Address <br /> �� <br /> Lot # <br /> Sub Division <br /> . , ,.�.. E .L"wt..r.,.; d(d..l -sse <YRk.i.9 +.ww t3' <br /> Parcel # <br /> � 4,01 , . t M ew ..., u ».. I, . .. ,.. <br /> ::.. ?,Ye�,u.' . uiw .,5d..:s.�r€,srswr,+.;sil"rn .�.- ,n�-.: .•fit .mow' •F4 .��ri.?�.a-,a:..« <br /> Blo- Hazard Waste Storage - ANNUAL r�1 <br /> I I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I 1 Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I - I Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> Jutrlyf 1Semi1 JfT1 rther I <br /> Sprinkler 71 ❑ ❑ ❑ 1 Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I <br /> Sparklers <br /> Hood Cleaning 71 ❑ ❑ ❑ I I I 1 Sprinkler System Installations <br /> Hood Suppression I ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps <br /> I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL f I <br /> Fuel Tanks <br /> ! Valuation of Project <br /> 7 Other: I <br /> Contractor .. . _lm $_: <br /> r <br /> Company <br /> Signature / .. L P Y 1/ <br /> Registered Y / N ] Fee Current I Y / N <br /> Address I <br /> License # <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y / N j Fee Current I Y / N j <br /> Address) <br /> License # <br /> PLUMBER <br /> Signature ( Company <br /> Registered Y / N j Fee Current I Y / N I <br /> Address I <br /> License # <br /> MECHANICAL <br /> Signature Company <br /> Registered Y / N j Fee Current 1 Y / N j <br /> Address ( I <br /> License # <br /> OTHER <br /> Signature I Company <br /> Registered Y / N J Fee Current I Y / N <br /> Addressj <br /> License # <br /> Directions: <br /> Fill out <br /> �..:;w..._ T..0 .. <br /> 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 hit //a <br /> ( P� ppraiser.pascogov.com) <br />