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813-780 -0020 City of Zephyrhills Fire• / �' F ax- 813 - 780 -0021 <br /> Permit Application / 3 <br /> Date Received y eA"6 0 J <br /> ,. O ipi Phone Contact for Permit • /3 <br /> ,�..,. ..«..- .-s .a � "'.s.R. _ �.. ,.... := :w. --,. .. i::.G .;,:F..S ... ri =.a.': •yq C.c.. s:.�4xtY i t: .":. �� <br /> �+ <br /> V V <br /> Owner's Name 1 n 1 Oriels r- 1 r 1 rt e_ Owner's Phone Number I I I I I <br /> Owner's Address 3 5 6.,w,ty tee- 5 ZPhyebr FA- 335 <br /> Fee Simple Titleholder Name Titleholder Phone Number I I I I <br /> Fee Simple Titleholder Address <br /> .:as:..� »P. ..lf .?'<rEir..brw ^S- ...+.e.ti- s-e. �. =.!:. . .: 3" 'e _ ✓ '^ $ <br /> Job Address 41'7/6/ 4rrport" Roo .d. Lot # I <br /> Sub Division 2c10/1 r Al r P Parcel # 1 3- a2Cc .I- e.tC)O-- ccrx,D- -va <br /> Bio-Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum Ii Hood Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> ItAtnyl !Semi' EMT 1 Other <br /> Sprinkler f7 ❑ ❑ ❑ f I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning I-1 ❑ ❑ ❑ I ( I I Sprinkler System Installations <br /> Hood Suppression r r ❑ ❑ I / I I I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> r-7 Fire Pumps I I Waste Tire Storage ANNUAL <br /> I - I Fire Works <br /> Fl Flammable Application- ANNUAL <br /> I 0 9 wx.p• cn...., ( Valuation of Project <br /> ri Fuel Tanks <br /> 1 Other: n 4 w Ynon.trs k U how •'• v - •rrob. en - ,•w-.,. <br /> Contractor �f� �7j`� Company / • //tit - pb/a- - F. rr /;yt.�, /.e <br /> Signature r + � Registered Y / N I Fee Current I Y/ N <br /> Address 1 17C)/ G....- 6-4rr l,e... Tom- 1 I License # r /163;2 0 0Q) gee? <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address I <br /> I License # <br /> I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address 1 <br /> 1 License # <br /> F <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address <br /> 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 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http:/ /appraiser.pascogov.com) <br />