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813 -78C )020 City of.Zephyrhills Fire. l d 1 q 1 Fax -813- 780-0021 <br /> Permit Application �J <br /> Date Received • Phone Contactfor Permit <br /> Owner's Name ��JJ��/�� — ,rV1 �/� `� _ � =21 Owne <br /> `' ` �• t��� t � 1 temoc LT? Owner's Phone Number 1 I I 1 1 <br /> ner's Address I ?Ca BOK 17'702 # W$ Q/ qv : �f ` <br /> Fee Simple Titleholder Name I ` I I Titleholder Phone Number I I 1 1 <br /> Fee Simple Titleholder Address I <br /> Job Address I 5'73/ 3/ 34et ioD 2 f /?7ciij(((j P/ 3 / <br /> _ o # <br /> Sub Division I _ <br /> Parcel # � • - (� � 041,24,z .. V VCdtl•CA� b <br /> Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Da Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtriyl ISemiI WA Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ 1 I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I 7 <br /> Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I Flammable Application- ANNUAL I ( Valuation of Project <br /> n Fuel Tanks <br /> In Other: I <br /> Contractor / de Company r:1�= 7L j LA 5 ■ <br /> Signature 4 L) Registered Y / N Fee Current Y / N ' <br /> • Address 1 541 ( l-v„ - ta 4ci . 7.4 I _ License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N j <br /> • Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N j <br /> Address I I License # • I <br /> MECHANICAL' Company <br /> Signature ` Registered Y/ N J Fee Current I Y / N I <br /> Address I 1 License # I <br /> OTHER I Company <br /> Signature I Registered Y/ N J Fee Current I Y/ N <br /> Address I I <br /> I 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 l /appraiser.pascogov.com) <br /> • <br />