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813- 780-0020 City ofZephyrhills Fire (Q `f \ Fax- 813- 780 -0021 <br /> Permit Application ''(/tom, 1( Pt <br /> Date Received Phone Contact for Permit MEM QA 1 1S ' 6 <br /> Owner's Name I /- 4 4 I fY f f s f C h t), , Owner's Phone Number l d l3 I ) 7 0 Z I O S( I <br /> Owner's Address 1386 ` , 3 '1 ("}W� cc{ 6 Z-e13It9le k0 1$ / , 33SY 7 '" ( &c..E /)o lied ,e,-....‘ /1- c/aftd /lc) <br /> Fee Simple Titleholder Name Titleholder Phone Number I I I <br /> Fee Simple Titleholder Address I I <br /> Job Address <br /> I Lot # <br /> Sub Division Parcel # <br /> , ,, ,. arc,. . ._ , .. • <br /> Bio- Hazard Waste Storage - ANNUAL ( Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> E Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> n Controlled Bum I] LP /Natural Gas - Installation <br /> Q Emergency Generator < 30 kw El LP /Natural Gas- ANNUAL Saie <br /> Emergency Generator > 30 kw 1 Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL I� Recreational Burn <br /> ❑ ry 'Semi Other <br /> Sprinkler ❑ ❑ ❑ n Sparklers <br /> Fire Alarm M ❑ ❑ A I I n Sprinkler System Installations <br /> Hood Cleaning ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I 0 Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation 1] Waste Tire Storage ANNUAL <br /> 7 Fire Pumps <br /> 0 Fire Works <br /> 1] Flammable Application- ANNUAL f ( Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor Company) <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I 1 License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N J Fee Current I Y / N I <br /> Address ( I License # I <br /> PLUMBER <br /> I Company I <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 I Fee Current 1 Y/ N I <br /> Address I 1 License # <br /> OTHER / Company _ A ' k k <br /> Signature / 1/ ��1.-� Registered 2101Ill Fee Current ran <br /> Address �� <br /> /7 pR' i I �O i/`. 4 P L 335:8 License # G1� �' 1 <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 />