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813-780-0020 City of Zephyrhills Fire, Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received r l f,.) Phone Contactfor Permit <br /> 1 I 1_ <br /> Owner's Name I (Ahl If -4lS I Owner's Phone Number l 11 ( <br /> lets Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I a-4-1( \ / <br /> Job Address ( - Z l blob - L`�Q (b 335'1, Lot# <br /> Sub Division 1 I Parcel # <br /> 1 ' Bio -Hazard Waste Storage ANNUAL r1 Fumigation Tent <br /> 1 Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier I1 or RQ Facility) ANNUAL <br /> 1 - 1 Controlled Bum 11 Hood Installation <br /> F T Emergency Generator < 30 kw El LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw LP /Natural Gas-ANNUAL Safe <br /> luny, Fire Protection Maintenance - ANNUAL n Places of Assembly -AI UAL r 11l 6 <br /> l uny, WI Semi) Uther / / 1 <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum f Al / v <br /> Fire Alarm [RI ❑ ❑ ..1 1 1 1 Sparklers <br /> Hood Cleaning 1 ❑ ❑ ❑ 1 n Sprinkler Syste Installations <br /> Hood Suppression 1l ❑ ❑ ❑ 1 1 7 Standpipes (Sprin r Sys) <br /> Fire Alarm Installation 1 Torch Roofing/ Tar Kettl f <br /> n K C <br /> Fire Pumps 1 Waste Tire Storage ANNUAL /� <br /> 1 Fire Works l• <br /> 1 Flammable Application - ANNUAL <br /> 1 I Valuation of Project <br /> I Fuel Tanks <br /> Q Other: I <br /> Contracto � Company — - T-- 00 t 7l 3craic <br /> Signature 4 4 VL <br /> T)E Registered Y/ N Fee Current L Y/ N I <br /> Address I q 7/ W w/4/ O 14(...).- 1 License # � f -'; 1 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> • <br /> Address I 1 License # I ( <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I L icense # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 1 License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address 1 1 License # I 1 <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 />