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813-780-0020 City of.Zephyrhills 'Fire. - ¢ � / 0� Fax- 813- 780 -0021 <br /> • Permit Application ` 1 . <br /> 9 <br /> Date Received I TOR 03 / /0 I Phone Contact for Permit c, 3 1 _4'5 IT S 51 <br /> Owner's Name L.- 4 LW R1 4 7 / l / / Owner's Phone Number 2/3 5 5 / • ,35/ <br /> Owner's Address '' B(O�( 7.9� / if4, -L- 336 •74 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> � 7-25 ' 64 v e / %s r.T..z. _ / 11e r �t w4 ,/ rt cT/ <br /> Job Address Cf/ /A /,4 W ,Lib 26P# W/J ,T Lot# <br /> Sub Division Parcel # <br /> I 1 Bio-Hazard Waste Storage - ANNUAL in Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> • <br /> n Controlled Bum I I Hood Installation <br /> n Emergency Generator < 30 kw - n LP /Natural Gas - Installation <br /> I 1 Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtrly' (Semi) 1""" 1 Uth <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning E ❑ ❑ I I I 1 Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> I Flammable Application - ANNUAL f ) Valuation of Project <br /> Fuel Tanks <br /> Other: I <br /> Other: <br /> . -..o.n . ,_.minx. u. .-i•� "3s.£. =sr, ,tr ... ;....:_: .,o _fir. -',^2 e ,:s- ..34� Y, .,. -v ,. xY!.e. 3, �. +. <._;ww . ,. v .-.._ .. >. -...,. .i.. ,_, ::4'. "i <br /> Contractor Co mpany //��V�j�S T �/��1C <br /> Signature Registered Y / N I Fee Current Y / N 1 <br /> Address I <br /> 1 License # I I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N j Fee Current I Y / N j <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N j Fee Current I Y / N j <br /> Address 1 <br /> 1 License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N j Fee Current I Y / N I <br /> Address 1 I License # I <br /> OTHER Company I <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address <br /> License # <br /> Directions: <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 />