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813-780-0020 City of.Zephyrhills "Fire. * (031 Fax- 813 -780 -0021 Permit Application l Date Received Phone Contact for Permit Z1 ,'S3D�4�'S2/ Owner wners Name If mc_ rieln A • 11 riYe I Owner's Phone Number Owner's Address - 3 ?1% nr∎ak 1 r . T1 t Vr 700-4%41;11s F 1 J3 2 Fee Simple Titleholder Name 1 Titleholder Phone Number Fee Simple Titleholder Address I Job Address 38d5i (Y)Grke 4- (Square_ Z. e hl i ✓it is Fl d350) Lot Sub Division �� Parcel # az..-2jn -7 1.coln -cL • .- onto FT Bio- Hazard Waste Storage -.ANNUAL n Fumigation Tent I I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL Controlled Bum I I Hood Installation FT Emergency Generator < 30 kw n LP /Natural Gas - Installation n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL IUtnyl Ibemml will Other Sprinkler n ❑ ❑ ❑ I I Recreational Bum Fire Alarm 1. ❑ ❑ * I I n Sparklers Hood Cleaning n ❑ ❑ ❑ I I 1 Sprinkler System Installations Hood Suppression n ❑ ❑ ❑ I n Standpipes (Sprinkler Sys) I 1 Fire Alarm Installation I I Torch Roofing/Tar Kettle I—I Fire Pumps n Waste The Storage ANNUAL Fire Works n Flammable Application- ANNUAL [ I Valuation of Project Fuel Tanks fl Othe • I NSM7- A + "a A .. Contractor 1 Company ,, oil r _ •, F • r I.1.1 , 0 • 71 •,P , Signature - i' -1A. Ait ' 1 1 ALA.,/ Registered irk= Fee Current 7 N Address I ' I License # IF F 000I6 78 f I ELECTRICIAN Company Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I PLUMBER Company Signature Registered Y / N I Fee Current I Y / N 1 Address I License # I MECHANICAL Company Signature Registered Y / N j Fee Current I Y / N I Address ( I License # 1 OTHER Company I Signature Registered Y / N I Fee Current 1 Y / N I Address License # Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required. (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 - 14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http:/ /appraiser.pascogov.com)