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813 -:80 -0020 City of.Zephyrhills Fire 1 05 7 Fax - 813 - 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> teaa3Y5& Scc" ,..,,,u�m:.•.,»w.. »�,.r.. -«.z«s .._ .::::�,= =..x;. m;,s» v,:se•aa'' ".. .yv�' ' A'° a .:' rsc«°.,. :;.w.xaax,.:t,:...a.:aaw..:.:. .. w+.rawae »., ».aa.;z.:., .,�c�..� ,..�..»,.,.. :.,. <br /> Owner's Name 1 F) o(l ova 4 j /Cc/ / G 1 C 1 Owner's Phone Number 1 I <br /> Owner's Address 3 ) 135 44e, rite 54 l4 ore, <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> c 1�:.'4` , `.' »;3 <br /> Job Address 13 /)l�r ,t ,'f ✓ U li /– e Lot # <br /> Sub Division Parcel # <br /> .sad. .. mac.. .n ..:ra- �a x�' ' yo-✓ .. e, «er,:a::: K % <br /> I 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 /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> yyt mergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IQtriyI ISemiI Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning n ❑ ❑• ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression I `/ ❑ L� ❑ 1 ( 7 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> FT Fire Works <br /> El Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> I Fuel Tanks <br /> n Other. I I <br /> ui� ' x ;Aa:.':.'%"cdc%CZd3++k a?3; °".? :. - ,.°ei!".,*.ijaw»"K;, ?r!?.,sn be;`f!�B/zY$�?a:i H ^`�">n9su Rr,..sht zk: a�', 1& Ri%f,+ g "6hi:✓'N.+"4ed`'.":..o,'dR!'::& .. '!mB 3.E'.`ii ,. <br /> Contractor , f Company ( I <br /> Signature . (iC�� Registered Y / N Fee Current I Y / N I <br /> Address 1 I License # I I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N I Fee Current I `MA I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I 1 License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N <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: / /appraiser.pascogov.com) <br />