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813-780-0020 City of.ZephyrhillsFire, Fax - 813780 -0021 <br /> Permit Application <br /> Date Received Z <br /> 3 (o - Phone Contact for Permit <br /> S( 3 1 1 J7313 <br /> _ <br /> Owner's Name ' C-91 j L L- Owner's Phone Number I Fl 3 1 1 33 11 6)(29 Y_e <br /> Owner's Address 3 (a Z`? h CAI 1 TPA t Ft. 33 6 ( S <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> <Thri.M: ,,r- „ +a ZECAMm �•, , 4:m °:rr � > � „„, bN.a , $, ' , :���4. .... t. __ . 41tItt�'�.,�..e°t'*M�z <br /> ‘ 7 Z$' �'A� (at 0 � <br /> Job Address <br /> Lot # <br /> Sub Division 9 ( L £ O, . Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> 1 Comm Exhaust Kitchen Hood /Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 1 - 1 Controlled Bum 1 Hood Installation <br /> I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> 1 Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL 1 I Places of Assembly- ANNUAL <br /> I Lttrly I I Semi 1 Other <br /> Sprinkler 7 ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning 7 ❑ ❑ ❑ 1 FR Sprinkler System Installations <br /> Hood Suppression u ❑ ❑ ❑ 1 1 Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps El Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I (2.. S , 00 ( Valuation of Project <br /> Fuel Tanks <br /> 1—I Other: 1 <br /> Contractor 1 „7"��'. Company �, 'S4 / , C .- .�. <br /> Signature <br /> p �1 n Registered M�� Fee Current 4!/ N <br /> Address 1 7 141 - ( 4P4�t0 D.t_, t ''`P4 l •- <br /> t 3 - 3-4 / `� 1 License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N . 1 Fee Current Y / N ,1 <br /> Address <br /> License* <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address 1 <br /> 1 License # 1 1 <br /> MECHANICAL Company <br /> Signature Registered Y / N _ Fee Current 1 Y / N <br /> Address <br /> 1 License # I <br /> OTHER <br /> Company <br /> Signature Registered Y / N j Fee Current I Y/ N j <br /> Address License # <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> tf 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 />