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E13- 780-0020 City of Zephyrhills Fire �Z V <br /> Permit Application / Fax- 813 - 780 -0021 <br /> Date Received I <br /> -. Phone Contact for Permit 1 717 1 944 2 1 1 9 3 <br /> _. 1 <br /> Owner's Name eS �I V � <br /> } _co dN 1 S J Owner's Phone Number gf/3 J (? 3 I 1 9 3 0 / <br /> U � I <br /> Owner's Address 1 g 7/f C/ at/1 II ‘ V If Ft 3 ass 9- <br /> Fee Simple Titleholder Name I 1 I <br /> I Titleholder Phone Number I I I 1 1 I <br /> Fee Simple Titleholder Address 1 <br /> Job Address 41'37 A -die" / 1 'p' 14/ tiv .. S Z 4 � / ,1 r // 33544,i 1 I <br /> Lot# <br /> Sub Division <br /> I I <br /> Parcel # <br /> ( _ f Bio- Hazard Waste Storage ANNUAL <br /> Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood /Duct <br /> E Hood Installation <br /> Controlled Burn <br /> El Emergency Gas - Installation <br /> Emergency Generator < 30 kw 1 I LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator> 30 kw <br /> Places of Assembly- ANNUAL <br /> l Xl Fire Protection Maintenance - ANNUAL I" I <br /> ❑ J Qtrlyl emi E\11)1 'Other I f I Recreational Burn <br /> Sprinkler 0 0 0 ❑ <br /> ® Sparklers <br /> Fire Alarm ❑ � I I <br /> Sprinkler System Installations <br /> ❑ Hood Cleaning 0 0 0 I 1 ❑ <br /> ❑ Standpipes (Sprinkler Sys) <br /> Hood Suppression .❑ 0 0 I I ❑ <br /> Torch Roofing/Tar Kettle <br /> F-7 Fire Alarm Installation <br /> Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> ED Fire Works <br /> 0 Flammable Application- ANNUAL I <br /> n Fuel Tanks Valuation of Project <br /> 7 Other: 1 <br /> Contractor <br /> Signature I Company A "r" 4-c, Sc ( u4 - 1 . 0 n - Int. I <br /> Registered I -" <br /> Y/ N Fee Current 1 Y/ N <br /> Address) 35 31 1 AN z4-on Q. Rd. <br /> 1 <br /> ELECTRICIAN' License# I E, r 00 00 1 -11-1 I <br /> Signature I Company l <br /> Registered I Y/ N J Fee Current 1 Y/ N <br /> Address I <br /> 1 License # 1 I <br /> PLUMBER <br /> Signature <br /> I Company I <br /> Registered I Y / N J Fee Current l Y / N I <br /> Address l <br /> MECHANICAL <br /> I License # l <br /> Signature I Company I <br /> Registered I Y/ N j Fee Current 1 Y/ N l <br /> Address I <br /> I License # ( I <br /> OTHER <br /> Signature I Company <br /> Registered Y / N J Fee Current I Y / N I <br /> Address I <br /> I License # <br /> Directions: --- ...::: _ I <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 />