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'. °L <br /> 913-780-N20 City of.Zephyrhills Fire "1'T Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received 3 6 � �� Phone Contact for Permit I e d. / 3 SO 3 <br /> Owner's Name g ) n.s 1tJ2 fJ &n Owner's Phone Number 81 3 78a 333 3 <br /> Owner's Address 5 ,V1y 8't <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> rn 1 .„r. >, Z ,i:_'F,+ "' .r3 .Erl s; N.` '...x'roa;'.. a€+ '£,..r:.,:MIEWW ERNMP' :t' nir l <br /> Job Address Lot# <br /> Sub Division Parcel # <br /> I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw 1 LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> IQtrlyl iSemrl Uther <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm ❑ ❑ �/) I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I n Sprinkler System Installations <br /> Hood Suppression 1 ❑ ❑ I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation Torch Roofing/Tar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> ET Other: I <br /> >_._au.u.u4.�mtr4 ft''�u nr a,.rzsatwm x9 " —..s n w <br /> �..�_... ati1 *a^nL'a"<ii.' .a air <br /> Contractor _ Company S n CS S <br /> Signature Registered Cl / N I Fee Current I Y / N <br /> Address I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current 1 Y/ K1 I <br /> Address License # I <br /> �.� <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 /> 1/11 Lat2),Lop <br />