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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 <br /> Owner's Name LL) P 1 OC1 3 be I Owner's s <br /> '' `` 1 �i Q. ( Phone Number <br /> � / 1 I I I I <br /> �� <br /> Owner's Address � ' . J� a' f:1 . t\\J D .2 EP i 1 I"1- 1 I 1 S rL 3354a <br /> Fee Simple - Titleholder Name Titleholder Phone Number I I 1 <br /> Fee Simple Titleholder Address 1 <br /> Job Address <br /> Lot# <br /> Sub Division • Parcel # <br /> Elio-Hazard Waste Storage - .ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct • n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> •n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Safe <br /> El Fire Protection Maintenance - ANNUAL • • Places of Assembly- ANNUAL . <br /> Mill ' emr nil' Utter <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> • Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ , I I I Sprinkfer'ystem installations <br /> • <br /> Hood Suppression 0 ❑ ❑ ❑ .1 1 I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> 1 Flammable Application- ANNUAL I Valuation of Project <br /> I Fuel Tanks <br /> n Other. _1 <br /> • <br /> Contractor - \ Company .)/` t `�`7� <br /> Signature V.....—.s. �C 1 \ CNCAN 1 C1/4 c l-- Registered Y / N Fee Current Y / N <br /> Address I License # <br /> ELECTRICIAN <br /> Company . <br /> Signature Registered Y / N j Fee Current I Y / N <br /> • <br /> Address <br /> I I License* I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N J <br /> Address I <br /> I License* <br /> MECHANICAL • . Company <br /> Signature . Registered Y / N _ Fee Current Y./ N <br /> Address I 1 • License # <br /> OTHER <br /> Company <br /> Signature Registered Y / N j Fee Current 1 Y / N j <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.(Meehanical 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 (httpJ /appraiser.pascogov.com) <br /> • <br /> • <br />