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813-780 -0020 City of Zephyrhills Fire (1020 Fax - 813- 780 -0021 Permit Application Date Received I Phone Contact for Permit 1 721 1 1 qy 2 1 I "I g 3 p Owner's Name IFj V_, �� Owner's Phone Number I )) el 11 IMO 11 SIO 1 Owner's Address 1 3 7 ‘02 g et ei 4. Y Zf phr h, //s / Pl. I? .91 o I Fee Simple Titleholder Name 1 I I I 11 1 Titleholder Phone Number Fee Simple Titleholder Address I �.. ., , ,. =c _ ._.,.;;. ^' ' � _�� ;; •gin s.:ee .._; �:. :.e Job Address 1 3 /V O€ 4" € ay WA Zt° ) / 1 Sub Divisin 1 J P Lot # Parcel # 1 Bio- Hazard Waste Storage - ANNUAL I Hazardous Material (Tier II or RQ Facility) ANNUAL n Comm Exhaust Kitchen Hood /Duct Ii Hood Installation n Controlled Bum LP /Natural Gas - Installation El Emergency Generator < 30 kw r LP /Natural Gas - ANNUAL Sale 7 Emergency Generator> 30 kw n Places of Assembly-ANNUAL I L I< Fire Protection Maintenance - ANNUAL Ii Recreational Burn � 'Semi1 NU Other � Sprinkler ❑ ❑ ❑ Ej Sparklers Fire Alarm 2 ❑ ❑ X I 1 1-1 Sprinkler System Installations Hood Cleaning 0 ❑ ❑ ❑ I .1 � Standpipes (Sprinkler Sys) Hood Suppression 1 ❑ ❑ ❑ 1 I Cl Torch Roofing/Tar Kettle I I Fire Alarm Installation 71 Waste Tire Storage ANNUAL a Fire Pumps 7 Fire Works [ ] Flammable Application- ANNUAL Ej Valuation of Project Fuel Tanks n Other: 1 +_. ->;:: _ u .._.. __ ..::..: .- i:u% . . =.5- :osi�. _ Contractor I Company A �' Q Signature ;'G so alt 1�01� - Inc- Registered Y/ N J Fee Current I Y/ N Address 3 531 141 ¢4 ,41111 e cal d I License# I ELECTRICIAN I >= F OODO �I�I 1 I I Company Signature Registered Y/ N 1 Fee Current I Y/ N I Address I License # I PLUMBER I Company I Signature Registered Y / N I Fee Current I Y1 N 1 Address I License # I 1 MECHANICAL' I Company Signature Registered Y/ N j Fee Current I Y / N I Address I, I License # I I OTHER I I Company I Signature Registered Y / N j Fee Current 1 Y/ N I Address License # I I Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)