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313- 780 -0020 City of Zephyrhills Fire / ///// va � " Fax -813- 780 -0021 Permit Application I Date Received 1 Phone Contact for Permit 11 XI' 119 y R 1 1 0 3 1 Owner's Name £MG1fa Id 1 1/ k I9 A d Q� � - f t/ �Q� ! 1 Owner's Phone Number I I gs/O I 7rji7 Owner's Address 3 9 60 4 W � 7.epti /1 3 3 � Yd v Fee Sirnple Titleholder Name I I I I I Titleholder Phone Number Fee Simple Titleholder Address I Job Address 1 160 4/ / �/ I V �A I I Lot # I Sub Division f Parcel # I I Bio Hazard Waste Storage - ANNUAL n Hazardous Material (Tier 0 or RQ Facility) ANNUAL F Comm Exhaust Kitchen Hood /Duct Hood Installation n Controlled Burn = LP /Natural Gas - Installation n Emergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale I I Emergency Generator > 30 kw L I Places of Assembly ANNUAL I X I Fire Protection Maintenance ANNUAL n Recreational Burn 1Qtrly1 1Sem(I T (Other Sprinkler Ix I ❑ ❑ I 1 I Sparklers Fire Alarm n ❑ ❑ ❑ 1 1 I I Sprinkler System Installations Hood Cleaning n ❑ ❑ ❑ I I I 1 Standpipes (Sprinkler Sys) Hood Suppression ❑ ❑ ❑ 0 I I 1 1 Torch Roofing /Tar Kettle n Fire Alarm Installation I I Waste Tire Storage ANNUAL I I Fire Pumps I I Fire Works n Flammable Application- ANNUAL 1 I Valuation of Project I- I I Fuel Tanks n Other I I Contractor Signature 1 --- I Company 1 A T - I 1 So lu i n Registered 1 Y/ N Fee Current I Y / N I Address 3531 lice .54-onG 1 License# 9 2353V000I2002, I ELECTRICIAN I Company Signature Registered Y/ N I Fee Current I Y / N I Address I License # PLUMBER I I Company Signature I Registered Y/ N i Fee Current 1 Y! N I Address I 1 License # I MECHANICAL( I Company I Signature Registered Y/ N 1 Fee Current I Y / N I Address I 1 License # I OTHER 1 I Company I Signature Registered Y/ N I Fee Current I Y/ N 1 Address I License # 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)