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' • 813 780 -0020 ' <br /> City of Zephyrhills - Fire Fax- 313- 780-0021 <br /> �} Permit Application <br /> Date Received d / Phone Contact for Permit I <br /> Owner's Name S TMPLEXG13 TNNELL Owner's Phone Number - 813 1626 1 5482 <br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name - ' Titleholder Phone Number I <br /> Fee Simple Titleholder Address <br /> i= a. . "'r "'� �.,,, Wit•.:: -_. 7 -;-4' ,a-; 'K:.,M2 r ` .. r- .1. Z' -.,E -r - - :�.� � o ' - <br /> Job Address 7 -11 Ci.c , it ZI vz . Ze Pn y r h ', i IS VI- " - I 1 Lot # <br /> Sub Division Parcel # <br /> —.», _.: •-• `.-r-: '-. .. :'=' .�- z:4.c «.; . . ' - F ,": .. ,..........` " _...: =.,y^:- ; . -,,.3 : .,. --.. ..-. a .'. - y ' a. <br /> I • I Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier If or RQ Facility) ANNUAL <br /> I I Controlled Bum I Hood Installation <br /> ,. <br /> I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> • I I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Safe , I q <br /> 0 <br /> I. I Fire Protection Maintenance - ANNUAL • I Places of Assembly - ANNUAL - 4r / D V <br /> t !Anil Other ( <br /> Sprinkler • f cu". ❑ ❑ , I I Recreational Bum <br /> D U <br /> Fire Alarm I I ❑ ❑ 0- I [ I I Sparklers 1 <br /> Hood Cleaning I 10 0 0 I I I Sprinkler System Installations <br /> - Hood Suppression 1 1 0 0 0 I I I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation <br /> 1 I Torch Roofing/Tar Kettle <br /> . ( I Fire Pumps Waste Tire Storage ANNUAL <br /> I I , Fire Works <br /> • <br /> Flammable Application- ANNUAL <br /> I I' 1 j Valuation of Project <br /> k Fuel Tanks <br /> • <br /> I I Other: . I . <br /> • <br /> F. - . _ : s''"'" ,:s'z? - - r ` ; -� xi .s.:s a s' -- ^ii 4' '' _ s s - :.4- a : - ; r - ire - -&— w . -:4 .. .,a r:. : . , .: ', ,xs€ c -;r,.: <br /> Contractor / Company -- cyr-- Ks.- ..--c. C( <br /> Signature Registered Y / N Fee Current I' Y / N j <br /> Address I L License* • <br /> ELECTRICIAN <br /> • _ Company _ . <br /> Signature <br /> - - Registered • Y / N j Fee Current I : :Y / N l <br /> Address I I License # I I <br /> PLUMBER _ Company _ <br /> Signature I - Registered Y / N A Fee Current' I Y / N I • <br /> Address I • <br /> I License # . I • <br /> MECHANICAL Company <br /> Signature Registered Y/ N J Fee Current 1 Y/ N j <br /> . Address I. <br /> I License # <br /> OTHER Company - . <br /> Signature Registered Y / N I Fee Current I Y / Ni <br /> Address I L' # <br /> License <br /> �k ...,. <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 />