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.813-780-0020 City of Zephyrhills Fire. Fax- 813780 -0021 <br /> . . .. Permit Application - Date Received . Litko. v Phone Contact for Permit 6 re , <br /> owners Name I 1,fiCn7L ?A <. y {1 41o( Owner's Phone Number Mill 172rA I (7 <br /> .vners Address I 4 qglt ( - D4 Ty 1 ZE1 ff `eet1(s ( 36c1 g- <br /> Fee e Simple Titleholder Name t") r . 0 ii '4 , b 1. ' 7'i"" > Titleholder Phone Number I I <br /> Fee Simple Titleholder Address 1 v 7 � /I 7) (F� � `_t <br /> Job Address Co 'AD( DA t's ( R� • Lot # <br /> Sub Division I 11 Parcel # 4-) oZ il.G'`r7 - '3.:)"c <br /> Bio-Hazard Waste Storage - ANNUAL Fumigation Tent <br /> a Comm Exhaust Kitchen Hood /Duct FT Hazardous Material (Tier 1I or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I — I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I—I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I Places of Assembly - ANNUAL ` �� <br /> Ic, ! tJ <br /> ttny) !Semi) fgal tither /0 Sprinkler Ei ❑ ❑ ❑ n Recreational Bum -11 f <br /> Fire Alarm ❑ ❑ X I I El Sparklers <br /> Hood Cleaning M ❑ ❑ ❑ I I I I Sprinkler System Instal 'ons c.----- ---------- <br /> _ ____— • r- <br /> Hood Suppression El ❑ ❑ ❑ 1 ( 71 Standpipes (Sprinkler Sys) <br /> I -1 Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> n Fire Pumps El Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application - ANNUAL ( I Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor �i ea e- IQrY"' ' 5a - c,A(�(lf <br /> Signature -+�1" i " oary Registered es) /N I Fee Current I 1:35 N I <br /> Address I 5 iv. (A64f31 1gcJS Tot't'er- I License # I 1 4 - 'Ftat3 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N ,I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N . 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N ] Fee Current I Y/ N I <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 (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•1 /appraiser.pascogov.com) <br />