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813- 780-0020 � City of Zephyrhills - Fire- <br /> Fax - 813 -780 -0021 <br /> � a Alt 5 Permit Application . 7 <br /> )ate Received 17 1 - Phone Contact for Permit , <br /> )wner's Name f c•;\°‘ S f- e_.-.114t. rc t 1 Owner's Phone Number 1 di 3 I }7 d / , <br /> owner's Address 39 / 3 5 dial( , c e P-4 b' I5o 5 le- I �► �i �l5 ' 1. 33 5 3 7 <br /> :se Simple Titleholder Name 1 I Titleholder Phone Number I ( 1 <br /> :es Simple Titleholder Address <br /> Job Address 39 135 C h a ,k. Y► t- Z ` Ze a 4 3 35 o Lot # <br /> Sub Division r %11® Parcel # - •, . -, - ..„0•0 • 100 - e.)056 <br /> d <br /> n ' Bio-Hazard Waste Storage - ANNUAL ED Fumigation Tent <br /> EI Comm Exhaust Kitchen Hood/Duct ED Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n 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 /> /0 19'j ..../ e; 'semiI (� Vther <br /> Sprinkler n ❑ ❑ ❑ n a Recreational Bum { <br /> Fire Alarm E ❑ ❑ , 1 n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ 1 1 u Sprinkler System Installation - -• - --- e <br /> Hood Suppression 0 1:1 CI I 1 a Standpipes (Sprinkler Sys) / I <br /> i' M <br /> Q Fire Alarm Installation n Torch_ Roofing/Tar Kettle / <br /> R Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 I Valuation of Project <br /> Fuel Tanks <br /> Q Other. I <br /> Contractor . Company • , c r:[ ✓�•riE L.t� $ ' 013 <br /> Signature : c Registered / Fee Current <br /> �Y <br /> Address S1 11:111 11ST�itt�w� � <br /> •�a. 4J License # F. 1000 164 tp I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N 1 <br /> Address 1 I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current Y/ N 1 <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y / N Fee Curren 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 52500, 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 />