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8'!3- 780 -0r?0 City of Zephyrhills Fire i (I° �� Fax- 813 - 780 -0021 .4 Permit Application l Date Received I I Phone Contact for Permit I I I I I I Owner's Name I Pi 27- 4 Alv Owners Phone Number Nis l .2 7 , ISss5 I Owner's Address 1 65 L i q ( 1 I (5 ` id • I Fee Simple Titleholder Name Titleholder Phone Number I , Fee Simple Titleholder Address Job Address 65 G -" ( 11 b L y(; , Lot # Sub Division I I Parcel # 7 Bio- Hazard Waste Storage - ANNUAL I Hazardous Material (Tier II or RQ Facility) ANNUAL EJ Comm Exhaust Kitchen Hood /Duct a Hood Installation n C ontrolled Burn n LP /Natural Gas - Installation I E mergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale I - I Emergency Generator > 30 kw n Places of Assembly- ANNUAL 7 F ire Protection Maintenance - ANNUAL n Recreational Bum IQtrlyi emi kW Other Sprinkler El ❑ ❑ ❑ [ ] Sparklers Fire Alarm TI ❑ ❑ ❑ I I [ ] Sprinkler System Installations Hood Cleaning El ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) Hood Suppression R ❑ V ❑ ( ( 7 Torch Roofing/Tar Kettle Fl Fire Alarm Installation n Waste Tire Storage ANNUAL El Fire Pumps I - 1 Fire Works r -- i Flammable Application- ANNUAL ( Z _SE), 00 ( Valuation of Project El Fuel Tanks El Other: I I Contractor � Company a l j E,� vi k�►'�� 4.41 Signature Registered Fee Current Y / N Address 1 36/9 Al 2.'" ✓. - m.:w.ti. ',, L- 7? /2...7 I License # 0 9 173 0 a D /19 85 I ELECTRICIAN Company I Signature Registered Y / N I Fee Current I Y / N I Address I I License # I PLUMBER Company I Signature Registered Y/ N I Fee Current I Y/ N Address I I License # I MECHANICAL Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I OTHER Company I Signature Registered Y/ N 1 Fee Current I Y/ N I Address 1 I License # I I 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)