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El. 3- 780 - 720 City of Zephyrhills'Fire c -_::. /ll '(( 1 Fax - 813 -780 -0021 <br /> Permit Application �—�! <br /> Date Received Phone Contact for Permit ? 2? J S Z 41 1 0 000 <br /> ,� ��, �-. � _ _ <br /> Owner's Name Lu O (`5 p (' / /•.�0 A 4— - Owners Phone Number 7 1 3 7 15 I / °Qc7 <br /> Owner's Address 378/ 3 /f'3- <br /> Fee SimpleTitieholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> z - ?yq;A3 no, •F,v - ...- 44,,.ds_;::_.. �.,, _ _ ,. _.. .. -.. :?M. :' 4 ?', ve.i u_&a..A ti < <br /> a� <br /> Job Address 37 8f.S / S ? - / 2 e /`s P1. 3354 Z Lot # <br /> Sub Division Parcel # <br /> ;,- :._ >• .. .�:, - . ,; - �,.,;.. ,,: ,> <: : : ,,:n. .. - :art s .,_�:w .. .-- .,:.r: ; > „�„„_ . a. ..:.:�; „c -r .....,:.m.a' =: - *. .. <br /> n 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 Burn n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> 1 I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL • n Places of Assembly- ANNUAL <br /> lUtnyI 'Semi s WI Utner <br /> • <br /> Sprinkler El ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ ❑ ❑ 1 1 n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 1 1 Sprinkler System Installations <br /> Hood Suppression ® ❑ X ❑ . I 1 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alam, Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> 1 Flammable Application- ANNUAL I 150 7 1 Valuation of Project <br /> I - 1 Fuel Tanks <br /> Q Other: I <br /> Contractor 'r/ ; = Company 7 1191A- RA � ' 0kr AVG?W f <br /> Signature Registered Y / N Fee Current 1 Y / N .7j.[, <br /> Address I License # F��Iit 0Ob0 g>: 0 <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 1 <br /> Address I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y / N j Fee Current I Y/ N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address <br /> 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: / /appraiser.pascogov.com) <br />