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813 - 780 -0020 City of.Zephyrhills Fire rax -o 1 o ou - uvc I . <br /> Permit Application _______44-(00. . _. <br /> Data, P,eceivr , i Phone Contact for Permit N 3 GZ/ /.3,1 7 <br /> �. d ., � ham _ • n . _. � : —•'- - , .. <br /> Owner's Name 11404 ✓/t .) AcrrI )G. e_cd, Owner's Phone Number . I <br /> Owners Address 11 dONS t1 te∎KCM m-rm; Ars /t.* CYAI# ) YO A/ 4 OO ✓L / <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 13 &AU- A. L[0°/- Y/:-// , LL S ) At,. Lot # <br /> Sub Division Parcel # 30 Zs' Z.) • ewe • also() - O000 <br /> E Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> EJ Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> F l Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ry }S emi' ( tither <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ I ( n Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ ( I n Standpipes (Sprinkler Sys) <br /> Fire Alarm installation = Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL Lit Z� p ( Valuation of Project <br /> Fuel Tanks <br /> Q Other: I I <br /> Contractor Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current f Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N j <br /> Address I I License # I I <br /> OTHER <br /> - Company , 42-.J / Git6r -, 4Z4I/ACe$7%S .stt. <br /> Signature ei.,, Registered 69/ N 1 Fee Current I Y/ N I <br /> Address - ., • O e ��� License# cf Z000/1/ 9 <br /> ._��•. a.a_... - .r..•.,,� -,ter <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 (httpi /appraiser.pascogov.com) <br />