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813 -780 -0020 City ofZephyrhills' "FIRE Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received **, Phone Contact for Permit 1 J <br /> Owner's Name Al 72 &4- Wks" `_ffm-44-Ai - 1)4 1 / 5/ C Br's Phone Number 13 771 ah, <br /> Owner's Address 3r2c'3 Abre fA <br /> Fee SimpleTitleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> 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 /> = Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> L 1 Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Iutnyl !Semi' Dm tither <br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning ❑ ❑ , l Sprinkler System Installations <br /> Hood Suppression ' ❑ AZ ❑ 1 I t I Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ) I Valuation of Project <br /> n Fuel Tanks <br /> Ei Other: 1 <br /> iEke !Fw &iw'w`.1�d =S.c .k`k. ✓.}t �M, P+ne ....'_hofisry ...L+r -. r .w,. .. .ydiz .,.�5'SSd. ,4e _:.s. .T.Y: n� _ n.. kau� aka+. - ....'Y: — "ai,Yiwi::'} i'4v,n ,Kdkekn..3t.r Y J yr"LC..' <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address 1 I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N j Fee Current I Y / N <br /> Address 1 I License # <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address 1 1 License # <br /> MECHANICAL Company <br /> Signature Registered Y / N - 1 Fee Current 1 Y / N <br /> Address 1 I License # <br /> OTHER Company ► 'fir ; E .;f" % ' - _ L <br /> Signature e►j-z^ Registered womb Fee Current mei <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 />