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813 - x5" -002u City of Zephyrhills Fire j j0 JCb Fax - 813-780 -0021 <br /> Permit Application <br /> Date Received • I 1 Phone Contact for Permit ( 7017 1 1 1 .171 1 IMMII <br /> Owner's Name I neL6A) r 1 Owner's Phone Nu 11 11 i <br /> Owner's Address 15-q31 • 1 7L v i1 , 261 N •i IL ► �..5 r � 7 37 7 ? i <br /> Fee Simple Titleholder Name I 1 Titlehotder Phone Number I 1 1 1 1 I <br /> Fee Simple Titleholder Address I - 7 I <br /> Job Address I c 73l N• (7 6z-vb. 2liir /� -u s P /7l 33s I L I Lot # I 1 <br /> Sub Division I I Parcel # I I <br /> El Bio -Hazard Waste Storage - ANNUAL I ---- I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> p Comm Exhaust Iftchen Hood/Duct ED Hood Installation <br /> E Controlled Bum E=I LP /Natural Gas - Installation 1 1 <br /> I Emergency Generator < 30 kw (—I LP/Natural Gas - ANNUAL Sale y ) 3 /) Q <br /> ii Emergency Generator > 30 kw Places of Assembly-ANNUAL /� <br /> kl <br /> Fire Protection Maintenance - ANNUAL r I 1 r [J Recreational Bum (CJ 4 <br /> Spriner 1 "° " "I o •- 0 Sparklers 6', A 3D . / <br /> Fire Alarm E ❑ ❑ ❑ I I El Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ I 10 Standpipes (Sprinkler Sys) <br /> Joked Suppression El ❑ ;Nl ❑ ( 10 Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation �� \\ n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> El Other: I I <br /> Contractor Company OiJ r''. r - -az)) _fibs <br /> Signature J ( . /f (/ I Registered tIITr Fee Current lirliZ,I <br /> Address 112 316f. r1)o2 /J _ Sf : I L YL. 3�/6I License # I I <br /> ELECTRICIAN Company <br /> Signature Registered I Y / N I Fee Current I Y / N I <br /> Address I 1 License # 1 I <br /> PLUMBER Company I <br /> Signature Registered I Y/ N I Fee Current I Y/ N I <br /> Address I I License * I I <br /> MECHANICAL Company I <br /> Signature I Registered 1 Y/ N J Fee Current I Y/ N I <br /> Address I I License* I I <br /> OTHER Company I <br /> Signature Refired I Y/ N . I Fee Current I Y/ N <br /> Address I I License # I I <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 (Mgsi /appraiser.pascogov.com) <br />