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813-780-0020 City of Zephyrhills "Fire. 4 ,, Fax -813 - 780 -0021 <br /> I Permit Application 1 b' ' >- _ <br /> Date Received . 13 4 t7� __ <br /> �- � ' :20 � � � Phone Contact for Permit • l <br /> Owners Name 1 f /t n Clet X 91 /fir Owner's Phone Number 1 1 1 1 <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 I <br /> Fee Simple Titleholder Address I I <br /> Job Address GC 74j C-> 6-eia f3it.,d • ) Lot# <br /> Sub Division Parr-s4-# " '�� <br /> n Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtnyl !berm' raj Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 . 1 1 Sprinkler System Installations <br /> Hood Suppression 7 ❑ I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps I-1 Waste Tire Storage ANNUAL ` <br /> n Fire Works <br /> l <br /> Flammable Application- ANNUAL I g I Valuation of Project <br /> I I Fuel Tanks <br /> I-I Other: I /4 S/. 6"ccc re1rar £ re- $ <br /> Contractor Company Mue. - Pb4 - P, r , /:Vl.cv <br /> ! <br /> / 1 <br /> j I-e- <br /> Signature 2 Registered Y / N ] Fee Current I Y / N <br /> Address L/70/ a&-4..... f.- t r- 6 [4+e_.: 41 1 License # r /Y & 321 co !L 9 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current I Y/ N 1 <br /> Address ( I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N ] Fee Current I Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I . <br /> Address I I License # <br /> 0 <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address � License # <br /> PMIi revsx + <br /> D <br /> ISWINEXEMENEVE <br /> irections: <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 (httpi /appraiser.pascogov.com) <br />