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813-780-0020 City of Zephyrhills Fire - , <br /> Fax-813-780-0021 <br /> • <br /> Permit Application (0'2:2') / _ <br /> e Received 0 �� S Phone Contact for Permit I 35 5 <br /> ner's Name I n'1 YrN Lt l' • J V r•A L p ,,,ed -1/43 PI K. Owner's Phone Number l` V M-- 3 . 3337 <br /> ner'sAddress q3a il tl , <br /> i Simple Titleholder Name Titleholder Phone Number l <br /> Simple Titleholder Address I <br /> ai 4:4- n 211451sT a, a s •,' .- •: ; a, ,. :,AF x' . T `§ t 43t1.lr , s .s.W .5., <br /> t Address ,Vm -Q / /, 0V Lot # /, <br /> a Division Parcel # lo )c ' ,1/ 0/ 00,AD') M5o <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct I 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 1 I Controlled Bum E l Hood installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw 1 ( LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assernbly- ANNUAL <br /> R r y 'Semi] Other <br /> Sprinkler ❑ ❑ ❑ I I Recreational Burn <br /> Fire Alarm ❑ ❑ ')1 1 1 El Sparklers <br /> Hood Cleaning Ei ❑ ❑ ❑ I I 1 I Sprinkler System Installations <br /> Hood Suppression 0 ❑ Q 01 1 1 I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> I 1 Fire Works <br /> H Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> n Other: I 1 <br /> / a.n�a <br /> ntractor 1 .z /J Company 5 9 p'Gf4 It V j /CGTl.d "vr G Sy 57-e <br /> nature Registered / N Fee Current I Y / N I / <br /> Address ( 1 License # 1 EF d © 6) /6 y6 1 <br /> ECTRICIAN Company <br /> ;nature Registered Y / N Fee Current Y / N <br /> Address 1 License # I <br /> UMBER Company I <br /> ;nature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I I <br /> CHANICAL Company I <br /> ;nature Registered , Y/ N I Fee Current I Y / N j <br /> Address 1 1 License # 1 <br /> HER Company <br /> )nature Registered ` Y / N Fee Current Y / N <br /> Address I �License # <br /> �- l .y;.,....; <br /> ections: <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 />