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u13- 780 -0020 I � Fax -813- 780 -0021 <br /> / <br /> City of Zephyrhills Fire W t 0" <br /> Permit Application <br /> Date Received I 1 Phone Contact for Permit I} 21- . 1q 1 -I. 1 I g a 3 <br /> Owner's Name t' r .fi"t"" " (' C It 1'144/0 / C01, Owner's Phone Number q/ 3 7t L 7h/ Y <br /> Owner's Address <br /> `6 ?) Tf y z D u t. z f l r A.'/ s I f. 33 5 <br /> [ <br /> � <br /> Fee Simple Titleholder Name I / + T Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 I <br /> Job Address 3 7f ??■1 1444. Pr. Zr. / NIA • 3 35V Lot# <br /> Sub Division Parcel # <br /> pi B io - Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> El Controlled Burn ri LP /Natural Gas - Installation <br /> r i Emergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I ,t i E mergency Generator > 30 kw [J Places of Assembly- ANNUAL <br /> I x I Fire Protection Maintenance - ANNUAL r Recreational Burn <br /> (Qtrlyl Semi' FT, l Other <br /> C Sprinkler x ❑ ❑ ( I I Sparklers <br /> Fire Alarm C ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ I 1 1 1 Standpipes (Sprinkler Sys) <br /> Hood Suppression 7 ❑ ❑ ❑ I I I I Torch Roofing /Tar Kettle <br /> [ ] Fire Alarm Installation I I Waste Tire Storage ANNUAL <br /> I I Fire Pumps <br /> 1 I Fire Works <br /> n F lammable Application- ANNUAL 1 I Valuation of Project <br /> [] I Fuel Tanks <br /> 0 Other: I <br /> Contractor Company A -r- 11 3 64_i o <br /> Signature ) Fee Current <br /> 9 � 1 � Registered Y N � <br /> Si Y/ N I <br /> Andress 1 3531 Viett54-or►t , I License # 4 Q 35 3 8000 I a 00 2. I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address I <br /> 1 License # I-- I <br /> PLUMBER Company <br /> Signature Registered Y / N ! Fee Current I Y / N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address I License # <br /> OTHER I <br /> Company <br /> Signature 1 Registered Y/ N Fee Current I Y / N I <br /> Address I I License # <br /> Directicns. <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 />