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813-7.30-0020 City of Zephyrhills Fire ,itioq--11 Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received I 1 Phone Contact for Permit 11 1 <br /> Owner's Name I F 1e ( itq Se V1 i n (' 419,( - 1-44) I Owner's Phone Number I 1 1 I I <br /> Owner's Address 1 (Ol Ot - \ f t,t Fa . 2 ep -v - i -1 Us, } L 3S--/ 2_ <br /> Fee Simple Titleholder Name I 1 Titleholder Phone Number I <br /> Fee Simple Titleholder Address I <br /> Job Address 1 (O 7 ■ 1 �� ( (� ZQ, D k(i r f L t 1 4s , f : ( Lot # <br /> Sub Division I I ` `7 Parcel # I O 2 2-to 2i- col "0 -0390D -06k 0 <br /> El Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 0 Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> 0 Controlled Bum = LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> EJ Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> ® Fire Protection Maintenance - ANNUAL = Recreational Burn <br /> 1771 ��Yl1 (ice d <br /> Sprinkler M ID ,x 0 Sparklers <br /> Fire Alarm ❑ ❑ CI I I n Sprinkler System Installations <br /> Hood Cleaning E ❑ ❑ ❑ I in Standpipes (Sprinkler Sys) <br /> Hood Suppression El ❑ ❑ ❑ 1 1 n Torch Roofing/Tar Kettle <br /> lEl Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> 0 Fire Pumps <br /> E Fire Works <br /> E Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> Q Other: I <br /> Contractor , r} <br /> lJ/ , <br /> Signature � Registered F�� Fe e Current /hi Company 00 ■' L - C- . t -. <br /> ir QQQFti - � r�7't <br /> / <br /> Address P • 00.6. N. „ 0 1, J , " W , - r" License # O c 7i <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> I License # 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 />