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813 -780 -0020 City of Zephyrhills Fire r`t . (0 2-.(42 5 <br /> Permit Application <br /> 1 Fax- 813- 780 -0021 <br /> Date Received I <br /> Phone Contact for Permit I} 2'} I I g y z I I 1 g q 3 <br /> Owner's Name 1 `{ [ � � 7 5 <br /> l I Owner's Phone Number I ' 3 I 1450& <br /> 1 <br /> Owner's Address 7 1(3 r &� , 8 r i /et, rc1 Zf/f r '€Y /s F/ 3 3 5// <br /> Fee Simple Titleholder Name I I I I I I <br /> Titleholder Phone Number l <br /> Fee Simple Titleholder Address I <br /> 1 7`f3 / 4 f( Rode ✓,rc/ � y <br /> Job Address � / � ( S � �/ 3 � � Y ( I Lot # I <br /> Sub Division I <br /> Parcel # I I <br /> I Bio- Hazard Waste Storage - ANNUAL fl Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> [I Comm Exhaust Kitchen Hood /Duct I Hood Installation <br /> ri Controlled Burn n LP /Natural Gas - Installation <br /> 7 Emergency Generator < 30 kw a LP /Natural Gas - ANNUAL Sale <br /> 1 1 Emergency Generator> 30 kw I I Places of Assembly-ANNUAL <br /> I x I Fire Protection Maintenance - ANNUAL I - 7 Recreational Burn <br /> © IQi Iseml� I/ n !Other I <br /> Sprinkler ❑ ❑ Sparklers <br /> Fire Alarm ❑ ❑ ❑ I I I <br /> Sprinkler System Installations <br /> I I <br /> Hood Cleaning ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> Hood Suppression I ❑ ❑ ❑ 1 I 1 Torch Roofing /Tar Kettle <br /> f-7 Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> I Fire Works <br /> I I Flammable Application- ANNUAL I El Fuel Tanks <br /> I Valuation of Project <br /> n Other: I I <br /> Contractor ntractor Company A -T— � <br /> i o� e C rr { i o Si Registered Y / N I Fee Current I Y / N I <br /> Address 3531 1 '.1-cnt <br /> I J <br /> License# 9 /35.37 1 00012 00 2 <br /> ELECTRICIANI I <br /> Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # <br /> PLUMBER I I <br /> Company <br /> Signature Registered L Y / N Fee Current Y / N <br /> Address I <br /> I License # I <br /> MECHANICAL I Company I <br /> Signature <br /> Registered Y/ N j Fee Current I Y/ N <br /> Address I I License # <br /> OTHER I I Company I <br /> Signature I <br /> Registered Y / N I Fee Current I Y / N I <br /> Address I I <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 />