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813-780 -0020 City of Zephyrhills Fire. 4 (o1 Fax -813 - 780 -0021 <br /> Permit Application <br /> Date Received M MUM tC::■ C. Phone Contact for Permit '7 �'c . <br /> Owner's Name I (f /41 C <. . ?c't . 1 Owner's Phone Number . -I j I 1374■ 1 p�, - <br /> net's Address I 5 V 7 f wi aiillizri / o Ttl v * <br /> Fee Simple Titleholder Name Titleholder Phone Number I <br /> Fee Simple Titleholder Address <br /> Job Address 3 7 g DitqlgtArri `J Z rPs( y R 4d ?f.$ ( Lot # <br /> Sub Division I Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n 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 /> ED Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> r - i Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> JUtrlyl JSemiI 1""' i Other <br /> Sprinkler k. ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm Yi.. ❑ ❑ pt I 1 n Sparklers <br /> Hood Cleaning Ei ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression I_I ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 I Valuation of Project <br /> I Fuel Tanks <br /> 0 Other: I <br /> weinumem <br /> Contractor Company amp" r y � <br /> Signature 4g6- 4k ,-1/41, Registered b'7 N Fee Current tE• <br /> Address I >II/ vr,/i c.//'f r S s I License # I e�'ow0 "23 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N _1 Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company • <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N j Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address 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 (httpJ /appraiser.pascogov.com) <br />