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813278b -0= City of Zephyrhills Fire. . <br /> Permit Application Fax-a-13-780-002i <br /> Date Received <br /> Phone Contact for Permit <br /> Owner's Name OM 1 <br /> I Owner's Phone Number I <br /> Owner's Address I S7v9 f s.id6� 7� 1 I Io G �+U <br /> Fee SimpleTitleholder Name I I Titleholder Phone Number I I 1 1 1 I <br /> Fee Simple Titleholder Address I <br /> ::,:.G;mt.:."uVae"i2xaAbx'�'mr x. ,:,F°kv°.y [a.1sz+d .A.,7r.,a'�.a.�,.. .hr;`•:.. _ <br /> I _; �.. a.:.,, .3......::, .:;:: ..,- sn.p „�:.W3,sa .±•'- ���s+ ..?fit; x. #.e�:� °�.m °w�?* ;W w ✓� <br /> Job Address <br /> I I Lot# I <br /> Sub Division <br /> Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw = LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> �utrryl 'Semi) (� I I Uther <br /> Sprinkler ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm n ❑ ❑ ❑ 1 l n Sparklers <br /> Hood Cleaning ❑ X ❑ 1 I n Sprinkler System Installations <br /> Hood Suppression ❑ jil ❑ I ( LJ Standpi <br /> 7 pes p'pes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I <br /> Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor ,- <br /> Signature <br /> I Company I <br /> Registered Y/ N j Fee Current I Y/ N I <br /> Address I <br /> 1 <br /> License # <br /> ELECTRICIAN' <br /> Signature <br /> ELECTRICIAN' Company <br /> Registered Y / N ] Fee Current I Y / N j <br /> Address I ( <br /> PLUMBER License # <br /> Signature I I Company I <br /> Registered Y/ N I Fee Current I Y/ N <br /> Address I I <br /> License # <br /> MECHANICAL' I <br /> Company <br /> Signature <br /> Registered Y / N j Fee Current 1 Y / N j <br /> Address <br /> 1 License # <br /> OTHER 1 W <br /> Signature ( Company \ / e C! ? L <br /> r 4 1 <br /> Re �J/ N / Fee Curiefl (D' N <br /> Address <br /> Directions: _ <br /> License # , C 0 c2S3`ok, GX , /. 20'0 ! 0 <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> tf 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 />