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A VI V <br /> S13- 7130 -0020 City of.Zephyrhills Fire Fax - 913750 -0021 , <br /> Permit Application <br /> Phone Contact for Permit " r C I A b(.i 6q <br /> Date Received t p <br /> Owner's Name J cV A rl y 5 - p f3 Q Owner's Phone Number $ 13 7 $ z- y Z7 2 <br /> Owner's Address 6 60 (o CT K a 2 L 11 S 3 � • •Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Address J 1 <br /> Job Address r__5 r ' -v Lot# <br /> Sub Division Parcel'# <br /> Bio-Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> • <br /> Comm Exhaust Kitchen Hood/Duct = Hood Installation <br /> Controlled Burn = LP /Natural Gas - Installation <br /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Emergency Generator > 30 kw n Places of Assembly- ANNUAL . <br /> CE Fire Protection Maintenance- ANNUAL n Recreational Bum <br /> • tty 'eml ___ Other <br /> Sprinkler El ❑ ❑ ❑ n Sparklers <br /> Fire Alarm El ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ 1 1 ' ] Standpipes (Sprinkler Sys) <br /> Hood Suppression. 0 ❑ ❑ / X ) ( Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation = Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> n Fire Works <br /> n Flammable Application- ANNUAL . 1 357 ( Valuation of Project <br /> Fuel Tanks <br /> Q Other, I I <br /> Contractor _— ��J��Aiii43 Company 2r-. Fytt +r i- L <br /> Signature Registered Y / N I Fee Current I Y/ N j <br /> Address I NG 430x gyp Ze.nd O 'GA 34/bi9 ( license# <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N j Fee Current . I Y / N <br /> Address I 1 License* I I <br /> PLUMBER • Company <br /> • Signature Registered Y / N J Fee Current 1 Y / N I <br /> Address 1 I License I • MECHANICAL Com <br /> Signature Registered. Y / N _I Fee Current I Y/ N <br /> Address ! 1 License* I I <br /> OTHER Company <br /> Signature Registered Y / N Fee Current I Y / N I <br /> Address License # <br /> Directions: <br /> . Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (O.r, copy of signed contact with owner) . <br /> tr over 52500, 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 trora PrgppCga Tex Notice (11.11c 1appraissr.pascogov.com) <br />