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• <br /> . 813 -780 -0020 • City ofZephyrhills'Fire,: <br /> Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received - Phone Contact•for Penult <br /> Owner's Name / EQONI 0 lt 1Q, `J LE`/AM CAUQ.Lt Owner's Phone Number C� <br /> 613 -1ENZ, IB <br /> . S l <br /> Owner's Address 3 89Z4 C &\\E 7PPWriZ_LXa LLS FL 3354Z . <br /> Fee Simple Titleholder Name Titleholder. Phone Number <br /> Fee Simple Titleholder Address 1 <br /> Job Address • Lot# <br /> Sub Division I • Parcel # <br /> n Bio- Hazard Waste Storage - .ANNUAL n Fumigation Tent <br /> - 1 1 Comm Exhaust Kitchen•Hood/Duct • n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Burn n Hood Installation <br /> • F Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n • Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL = Places of Assembly- ANNUAL . <br /> lLttrlyl •) Semi I Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Burn <br /> • Fire Alarm • E ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning IT ❑ ❑ ❑ I I n Sprinkler 'System installations <br /> • Hood Suppression El • ❑ ❑ ❑ .I ( n Standpipes (Sprinkler Sys) • <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL M I Valuation of Project <br /> Fuel Tanks <br /> Other: <br /> ) 6.3.1 Ai u t t- 6S Se►-•1 i3L.`j port t't 1 . <br /> _ r Company ., .., <br /> Contractor t <br /> Signature till' ,� ; L <br /> Y /.N j Fee Current I Y / N <br /> Address I License # <br /> ELECTRICIAN Company . <br /> Signature Registered Y / N Fee Current I Y / N I <br /> Address 1 I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N I <br /> Address 1 . I License # I <br /> MECHANICAL • Company <br /> Signature . Registered Y/ N 1 Fee Current I Y/ N I <br /> Address ) 1 • License # I <br /> OTHER Company <br /> • <br /> Signature <br /> Registered Y/ N ,1 Fee Current 1 Y! N <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 (http / /appraiser.pascogov.com) <br /> • <br /> • <br />