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813-780 -0020 City ofZephyrhills Fire... - Fax- 513-780 -0021 <br /> Permit Application <br /> Date Received . - Phone Contact for Permit 1 <br /> Owner's Name 4 / Al/ 4 L <br /> .,_ ji Owner's Phone Number l <br /> Owner's Address 292 V ALL ,4€ 1(d/es/et c4C/ P2 3.3SV.'S <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple7itleholder Address <br /> / p /^=' Q / ` / <br /> Job Address COG /'S 61 // 13/ ✓d Z�D9 /r /S �Z . '338'1/ - Lot # <br /> Sub Division / Parcel # I <br /> I Bio-Hazard Waste Storage - ANNUAL = Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood /Duct FT Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I Controlled Bum FT Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL r---1 Places of Assembly- ANNUAL <br /> r y !Semi I WU other <br /> Sprinkler n % ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I ( n Sprinkler System Installations <br /> Hood Suppression = ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation - = Torch Roofing/Tar Kettle <br /> I Fire Pumps I] Waste Tire Storage ANNUAL <br /> H Fire Works <br /> Flammable Application- ANNUAL I ' Valuation of Project <br /> n Fuel I ,331-0' <br /> i_ ce - <br /> �,_ .. <br /> Contractor Company I r_• g - <br /> Signature Registered Y / N . 1 Fee Current I Y / N 'ti`s <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I 1 License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I License # <br /> • <br /> MECHANICAL Company <br /> Signature Registered Y/ N j Fee Current I Y / N - I <br /> Address 1 <br /> 1 License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 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 l /appraiser.pascogov.com) <br />