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• <br /> 813 - 780 -0020 City of Zephyrhills Fire .4 (pt-1- 5 Fax- 813- 780 -0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit I 1 1 1 1 I <br /> Owner's Name r &i I Owner's Phone Number 1 IZ]� r �• — '✓ �� <br /> Owner's Address L 1 ly G- 1 11 61 tc <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> • <br /> Job Address (I 1 a Ga 1 1 • 6 Ii vi ' Lot # <br /> Sub Division I Parcel # . <br /> n Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Burn n LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n E - mergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> n Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> IQtrlyI 'Semi' raj Other <br /> Sprinkler n ❑ ❑ ❑ n Sparklers <br /> Fire Alarm n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Cleaning n 0 / ❑ I I IT Standpipes (Sprinkler Sys) <br /> Hood Suppression I ❑ l ❑ 1 1 ri Torch Roofing/Tar Kettle <br /> n F ire Alarm Installation in Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> n Fire Works <br /> n F lammable Application- ANNUAL I Z..� T ' <br /> • 00 I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I I <br /> Contractor Company A ri j re & p14 I <br /> Signature Registered j f Fee Current 1 Y/ N I <br /> Address 1 36/9 1J• . - 2..^h'4 0 2 - !v►:t - 1 f L.- 7? /Z-7 I License # ( 0 / 9 f 73 0 c+ o a 9 g 5 I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address 5 I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # l I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 5 I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <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 />