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613 -780 -0020 City of.Zephyrhills Fire <br /> Fax - 813 - 780 -0021 <br /> :Permit Application <br /> Date Received r '-'7 – <br /> _ .. .. Phone Contact for Permit 3 V t <br /> Owner's Name 2P) - ' p? V...4-4f-t> r( �,, E -,,,,,c_...„9.4-r-,-._74 per's Phone Number I I J 11 <br /> Owner's Address 0 e. " – }{ ' o <br /> Fee Simple Titleholder Name Titleholder Phone Number I I 1 I I <br /> Fee SimpieTitleholderAddress I <br /> Job Address igl>l CC, – 7":"'.41 .4 Vf I II <br /> Lot# <br /> Sub Division <br /> e <br /> Parc l # <br /> Bio -Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> 7 Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> ] Fire Protection Maintenance - ANNUAL n Places of Assembly -ANNjJ <br /> 1Qtrty)'Semi' Other 5 Sprinkler ❑ ❑ ,,f1_ I Recreational Bum I /106 <br /> Fire Alarm ❑ ❑ ❑ I 1 1 1 Sparklers 1 /// <br /> Hood Cleaning E ❑ ❑ ❑ I I n Sprinkler System stallation <br /> Hood Suppression n ❑ ❑ ❑ I ( n Standpipes (Sprinkler <br /> rI Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I �� <br /> Fire Pumps ��� /�/ i� n Waste Tire Storage ANNUAL <br /> Fir Works <br /> n Flammable Application- ANNUAL I <br /> 7 Valuation of Project <br /> Fuel Tanks <br /> f ] Other: I <br /> Contractor an <br /> Compy <br /> Signature j1'� �1,'Rio1 T7C) <br /> Registered Y/ N j Fee Current 1 Y/ N j <br /> Address License # <br /> ELECTRICIAN ( Company <br /> Signature I Registered I Y / N j Fee Current I Y / N j <br /> Address I I License # <br /> PLUMBER I I Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I ( License # I 1 <br /> MECHANICAL' I Company <br /> Signature 11 Registered I Y/ N 1 Fee Current I Y/ N j <br /> Address I ( License # I <br /> OTHER I Company <br /> Signature Registered I Y/ N 1 Fee Current I Y / N I 1 <br /> Address <br /> 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 />