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813-780 -0020 City of ZephyrhillsFire •7...: Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact•for Permit <br /> .. .•7, ,_.. • <br /> Owner's Name / L J /GS Owe _ <br /> rs Phone Number J'J S — / <br /> Owners Address syya iL R4! 267:<p-LA F. • <br /> Fee Simple Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> FT Bio-Hazard Waste Storage -.ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw n LP /Natural Gas- ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> gyp !SemiI fain Other <br /> Sprinkler El ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ I I n 'Sparklers <br /> Hood Cleaning 71 ❑ x4 ❑ I I Ti Sprinkler System Installations <br /> Hood Suppression ❑ A ❑ . I I n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation U1. n Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I ( Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current I Y/ N 1 <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I 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 Fee Current 1 Y / N I <br /> - <br /> Address I I • License # I I <br /> OTHER Company _...1 , ,,7 ,C,t 4'...4'...N., A� • w �.r vT Z. LC- <br /> Signature �^ ' �� --y'1 t. Registered ream Fee Current OS <br /> Address <br /> License # -, .} i _ar <br /> Directions: <br /> �._.,. 9 <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 /> • <br />