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813-780 -0020 City of Zephyrhills Fire- i 6 ^ Fax - 813 - 780 -0021 <br /> / Permit Application 1 <br /> Date Received .6 ' 3 v� / C7 Phone Contact for Permit MAI 4 7,Se' <br /> . <br /> Owner's Name )n L.- Co nd crl 1 tl f C.r.r1 5 Owner's Phone Number 1 1 I .I = I <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> :::::: . ... -f J � j� -z? / x. <br /> 3 833 3 ( d `'V� L''��c- ` ` a �'e-- Lot # <br /> Sub Division Parcel # 1 <br /> - blo- Hazaro wasTe"Slmage AMIL I I Fumigation Tent <br /> W ' Comm Exhaust Ki - I - . • • • - - - 1 I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> W.. Controlled Bum I <br /> Hood Installation <br /> I] Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL [I Places of Assembly- ANNUAL <br /> It2trly) 'Semi) 1 1 Other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ ( J I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression r t ❑ n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> ( Fire Pumps [ I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> El Flammable Application- ANNUAL I • vv ( Valuation of Project <br /> Fuel Tanks <br /> fl Other I /Ii fG- 6- t4.0.1.a.1 rrc 4 5_ prr- .+Srcn 5 <br /> Contractor 1� , t~ Company � - posa - F.rt p•yL�.-. i'e -..<. <br /> M, I <br /> Signature J Registered Y/ N I Fee Current Y/ N <br /> I I <br /> Address I L1701 !iG !t 1. r 4..6 toe.- "r i_ .r t 1 License # // 1 062O j , 9. <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N Fee Current I Y/ N <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I <br /> I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <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 />