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. 513-780 -0020 City ofZephyrhills'Fire: <br /> Permit Application Fax-813-780-0021 <br /> Date Received - <br /> ,,. Phone Contact for Permit , "! - 33/9 <br /> ! veS �rG i G� Owners �. :. <br /> Owners Name ,y�-jy C Phone Number , $V 3 11712 1 173 /D <br /> • <br /> Owner's Address 3.11 C 4'c 2 ey4 -.4 / / 333'/ <br /> Fee Simple Titleholder Name Titleholder. Phone Number 1 1 1 I I <br /> Fee Simple Titleholder Address 1 <br /> Job Address 59iric <br /> Lot# <br /> Sub Division Parcel* <br /> n Bio-Hazard Waste .. . . .• , <br /> Storage -ANNUAL n Fumigation Tent <br /> l Comm Exhaust Kitchen • n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum 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 /> Fire Protection Maintenance - ANNUAL • • n Places of Assembly- ANNUAL . <br /> 1=1' 'ISemii Other <br /> Sprinkler ❑ ❑ ❑ 1 Recreational Bum <br /> Fire Alarm ❑ ❑ hF ` 1 1 n Sparklers <br /> Hood Cleaning ❑ ❑ (❑ 1 1 1-1 Sprinkler System installations <br /> Hood Suppression n ❑ ❑ ❑ .1 I 1-1 Standpipes (Sprinkler Sys) • <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> 0 <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL • I Valuation of Project <br /> • <br /> Fuel Tanks <br /> n Other: . <br /> Contractor /� _ . ,•_,. -: _ ,..,:. <br /> Signature ��r>� Company Vie � /rc�rr <br /> Registered �r" N Fee Current I Y / N _ <br /> Address X39 //e 1 .1 5 ,...44., - e £.R v ja/s , / • -. . <br /> 3 3 S'/dI License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current I Y / N j <br /> Address I <br /> I License # <br /> PLUMBER Company <br /> Signature • <br /> Registered Y / N I Fee Current 1 Y / N <br /> Address 1 I <br /> License* <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current _ Y' / N I <br /> Address I 1 • License # <br /> OTHER <br /> Company <br /> Signature Registered Y / N j Fee Current 1 Y / N i <br /> Address . <br /> e -, 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 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpJlappraiser.pascogov.com) <br /> • <br />