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5 <br /> CF <br /> 813 -780 - 0020 1 ,✓ -/ 0 City of Zephyrhills'Fire. Fax -813 -780 -0021 0"(0); ,/, Permit Application <br /> late Received Phone Contact for Permit I <br /> )wner's Name /g v in Owner's Phone Number ( l 1 <br /> )wners Address 1 5 3 3 1 r On ` e Dr 2'Q,p r i �' I— J S ( 3 35 W 7 /7 <br /> =ee Simple Titleholder Name F n Titleholder Phone Number l 87 ! 1 71/ k 9'7 : <br /> :es Simple Titleholder Address I <br /> Job Address d 1 „ t k s. v v 'e. Pitt/ e • 2' LI Is Lot # <br /> Sub Division IIE UOMEV C • On P arcel # - J / - 0000 <br /> n Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> in Controlled Burn = Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP/Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> •;� 'Semi) (� Vther / j � /� <br /> / L, <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum <br /> Are Alarm E ❑ ❑ % 1 1 ED Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installatio <br /> Hood Suppression Ej ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch_Roofing/Tar Kettle <br /> R Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works • <br /> Flammable Application- ANNUAL l I Valuation of Project <br /> Fuel Tanks <br /> n Other. I <br /> Contractor Company MEMiI ±RU �M d, rc <br /> Signature rr...∎ _ Registered mum F . Current rR <br /> Address ��L L s -e !,MPSIII - e ' TIF21 License # E fr 1 ' U ( 4 Li, I <br /> ELECTRICIAN 3 4 S) Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I I I # I I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address i ( License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered ` Y/ N I Fee Current I Y / N I <br /> Address I I license # <br /> , . 1 <br /> Directions: q; <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) . <br /> if over 52500, a Notice of Commencement is required (Mechanical work over 55000) . <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 />