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813-780-0020 4 ../)7411•1& City of Zephyrhills - Fire. Fax-813-780-0021
<br /> Permit Application
<br /> Date Received 5 - - IL - Phone Contact for Permit 1
<br /> Owner's Name STMPTLF,XGRTNNELL Owner's Phone Number 813 626 5482
<br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee SimpleTitleholder Address 1
<br /> ,.,--r:6•. -.J ,,,,,.*-- -==:==~. - " ,,,, WV , Ir•WW - = " .-,,,,, ....,, -.-,,,--...-: , —
<br /> Job Address - 735c7 N I) ck'i r 1 ---,V - Z.f. Rot r hi‘‘S .cl___ 355(40 Lot #
<br /> Sub Division Parcel #
<br /> I I Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent
<br /> 1 1 Comm Exhaust Kitchen Hood/Duct 1 Hazardous Material (Tier If or RQ Facility) ANNUAL: -
<br /> 1 1 Controlled Bum
<br /> 1 Hood Installation
<br /> 1 1 Emergency Generator <30 kw I LP/Natural Gas-Installation /
<br /> 4 ? 9
<br /> ‘ l
<br /> . 1 1 Emergency Generator > 30 •kw 1 LP/Natural Gas-ANNUAL Sale /0 /
<br /> J• Fire Protection Maintenance - ANNUAL
<br /> 1 Places of Assembly-ANNUAL
<br /> AIL= Semi l 1A:1 Other
<br /> Sprinkler MI 0 CI 1 Recreational Burn
<br /> Fire Alarm 1 1 0 0 0 1 1 1 Sparklers
<br /> Hood Cleaning 1 1 0 0 0 1 1 1 1 Sprinkler System Installations
<br /> Hood Suppression I 1 0 0 0 I 1 1 Standpipes (Sprinkler Sys)
<br /> 1 Fire Alarm Installation - 1 Torch Roofing/Tar Kettle
<br /> . I Fire Pumps 1 . Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> • 1 Flammable Application- ANNUAL
<br /> I I Valuation of Project
<br /> 1 Fuel Tanks •
<br /> 1 Other: 1
<br /> ..",A ,....,,,,,. ,,' ., ,,,-, , 3 , :-,,,tiW —===-4=' 3 ^, „I- - , ^- , - , ... ,,, ,,,,",,,I. , -;' ., ,,,,,, „,..., •,,, ,,, ,,,,,:,,... ,■,,,...,',,,,.. &' *,,,,,,,, xl Is . 1.. , ,Z,R ,, a.1 ,,,,....L. _ey.4,,===,==, ==.. = , =. -== t= 33. 4---V* %rat., i - -, .L ,,,,,,,,...-
<br /> Contractor ir dir
<br /> i; ' Company ( Ae, Kfiel+-. e(
<br /> Signature ' Registered Y / N I Fee Current 1' Y / N 1
<br /> Address 1 , License # - ' I
<br /> .
<br /> ELECTRICIAN T Company
<br /> Signature - . Registered Y / N j Fee Current 1 y / N
<br /> Address 1
<br /> 1
<br /> License #
<br /> . •
<br /> PLUMBER .., Company
<br /> Signature Registered Y / N ' 1 Fee Current 1 Y / N j
<br /> Address 1
<br /> I License # . •
<br /> MECHANICAL Company
<br /> Signature Registered Y / N 1 Fee Current 1 Y / N j
<br /> Address 1
<br /> 1 License #
<br /> 1
<br /> OTHER Company .
<br /> •
<br /> Signature Registered Y / N 1 Fee Current 1 Y / N _1
<br /> Address License #
<br /> Directions:
<br /> Fil/ 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. Parcef # - obtained from Property Tax Notice (http://appraiser.pascogov.com) •
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