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813-780-0020 City of Zephyrhills Fire <br /> Permit Application Fax-813-780-0021 <br /> Date Received Mg/012271A h 1 1 <br /> -. - .�,..� . �.b,,.�,,�„:,.,. �,- :K;�.•�s Phone Contact for Perm <br /> Owner's Name 1 4)11 iM✓ .4. A 7' 7/ Owner's Phone Number I or-73 . I I ?44 1 -r77.2 <br /> Owner's Address I'.-C ' cy.-- 57,,ee -7 /'/ /..--Z.- /..--Z.- Fee Simple Titleholder Name ( I <br /> Titleholder Phone Number I I I I I <br /> Fee Simple Titleholder Address i <br /> Job Address 1 Lot # I I <br /> I <br /> Sub Division J Parcel # <br /> 1 <br /> .sue I <br /> Bio- Hazard Waste Storage - ANNUAL 7 <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material <br /> (Tier II or RQ Facility) ANNUAL <br /> J Controlled Bum Hood Installation <br /> n Emergency Generator < 30 kw <br /> ri LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw = LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I -1 <br /> I 1 Places of Assembly - ANNUAL <br /> (otrlyI �Semi� 'Other I <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I I <br /> Sparklers <br /> Hood Cleaning 5 ❑ 1o�f /'� ❑ I 1 <br /> Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I I El Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I - 1 Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- on- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor �r <br /> Signature i I Company I <br /> Registered I Y/ N J Fee Current I Y / N j <br /> Address I ( I <br /> License # <br /> ELECTRICIAN <br /> Signature I I Company I <br /> Registered I Y/ N j Fee Current I Y/ N <br /> Address I <br /> I License # I <br /> PLUMBER <br /> Signature I Company I <br /> Registered I Y/ N _1 Fee Current I Y/ N I <br /> Address I I I <br /> License # <br /> MECHANICAL' I <br /> Signature Company I <br /> Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> OTHER License # I <br /> I Company r "4 <br /> Signature �1 C:04-3,'"1- - /e - �11 •L• � <br /> Registered iratign Fee Current I/ <br /> Address <br /> License # I' i 00U - , <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 htt //a <br /> ( P: pPraiser.pascogov.com) <br />