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813780 -0020 City of Zephyrhills Fire. ( 0 y Fax - 813 - 780 -0021 <br /> Permit Application <br /> Date Received <br /> �s °° �_ - Phone Contact Permit <br /> P tact for P <br /> Owner's Name U • • : N ' , 4 . e u • . . Owner's Phone Number - 813 i I 626 115 4 8 2 <br /> Owner's Address 1 4701. Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name 1 • E Titleholder Phone Number I 11 11 <br /> Fee Simple Titleho !der Address i <br /> � .... �`?� -: - -4,...t, ` gi°. _ : °�.. <br /> .1` �"° <br /> " '•-�"r'� "?�,: <br /> = -..o- �°..: ri.��° . ,, ^,.•^ <br /> Job Address 7,r'5Q -°''�, �.'t +11 - - �r " hiy�1��is VI— 3 i )3Ltc Lot # <br /> Sub Division I 1 Parcel # <br /> t, -r.._ '- r ,s,. 1,;,, h ,._.ro .• <br /> I I Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> I 1 Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier If or RQ Facility) ANNUAL <br /> I . f - Controlled Bum Hood installation <br /> I ' Emergency Generator < 30 kw . <br /> LP /Natural Gas-Installation <br /> I. I Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> • <br /> I" " I Fire Protection Maintenance - ANNUA ... _ - Places of Assembly- ANNUAL <br /> •I Mr 'Smri jAnl ( Other <br /> � J f <br /> Sprinkler. ❑ ❑. • Recreational Bum <br /> ,' Fire Alarm f 1 ❑ ❑ ❑• 1 I 1 ' Sparklers <br /> I 1=1 El I <br /> Hood Cleaning p Sprinkler System lnstaflationJ <br /> Hood Suppression o O ❑ <br /> Standpipes _I ( Sprinkl dprp r Sys) <br /> F e <br /> Fire Alarm Installation f " Torrfi Roofing/T ar Kettle <br /> i l Fire Pumps __ . _ . <br /> I • j • Waste Tire Storage ANNUAL - <br /> I I " Fire Works <br /> I Fue Tankls Application- ANNUAL <br /> / . f f Valuation of P roject • <br /> : ` <br /> .... ... _ <br /> I • 1 " . Other: <br /> • <br /> Contractor / Company • (Hti <br /> Signature A.:41...; r'^"`t C <br /> / �i Registered Y / N Fee Current • Y / N • <br /> Address i <br /> Li # • ELECTRICIAN Company _ s. Signature <br /> Registered Y/ N I ,Fee Current I Y/ N I Y <br /> Address <br /> ' 1 License # i 1 <br /> PLUMBER , <br /> Company <br /> Signature ) - I Registered Y N ' <br /> g / Fee Current Y / N . '• ': • <br /> Address I i License # , I • i <br /> MECHANICAL l - i Company <br /> Signature Registered 1 Y/ N j Fee Current I Y/ N <br /> Address - <br /> I- ' 1 License # I <br /> OTHER I <br /> I Company <br /> Signature Registered Y/ N j Fee Current I Y/ N . J <br /> Address <br /> License # <br /> Directions: <br /> • - - Filf out application completely. <br /> - <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 (httpf /appraisecpascogov.com) <br />