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813-780-0020 & 014 <br /> City of Zephyrhills -Fire. tr, / Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received J <br /> P hone Contact for Permit IllI <br /> Owner's Name 4 a Owner's Phone Number - 81 3 62 6 15 4 8 2 <br /> Owner's Address 4701. Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name I • - I Titleholder Phone Number 1 <br /> Fee S imple Titleholder Address 1 . <br /> Job Address G7 i 1 C g \` Ztvl‘ 2tp l (N t ∎15 c'L 3 t-di. Lot # I <br /> Sub Division Parcel 4 <br /> t Bio-Hazard Waste Storage - ANNUAL l I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier If or RQ Facility) ANNUAL <br /> Controlled Burn I I Hood installation <br /> I 1 EmergencyGenerator < 30 kw I ! LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw 1 (_ LP /Natural Gas - ANNUAL Sale <br /> 1• - I Are Protection Maintenance - ANNUAL • I I Places ofAssembly-ANNUAL <br /> . I Utrlyl 'Semi I IAn! I =am , <br /> Sprinkler, I I ❑ " ❑ ❑. • ( ( Recreational Burn <br /> ' Fire Alarm , �❑ ❑ '.. 1. . <br /> s" <br /> • 1 1 1 Sparklers <br /> Hood Cleaning I I O' ❑ ❑ 1 1 1 1 Sprinkler System Installation1 <br /> Hood Suppression _ a 1 ❑ ❑ ❑ 1 1 I I Standpipes (Sprink Sys) <br /> tandpip le r <br /> I I• Fire Alarm installation 1 I Torch Roofing/f ar Kettle <br /> IT Fire Pumps ' ( . Waste Tire Storage ANNUAL <br /> f -, L' Fire Works • , , • <br /> 1 Flammable Application- ANNUAL - <br /> ' / ' I I Valuation of Project <br /> Fuel Tanks <br /> 1' .. 1 . Other: I <br /> • <br /> R1 L.r, -,-.---...L,, ,, ,,6Ys 9_Fb b' ,,,,. n .,,,, c v`,.... ..g., ,, . CM'y -:: '1 .x_ _ . _,,, -. - t m , _.. -rte[ :A» _ ... <br /> Contractor Company 3 4-1-7 -' a.* . S, (- <br /> Signature Registered Y / N ' Fee Current ' Y / N • <br /> •. Address 1 ` <br /> a •: License # <br /> ELECTRICIAN ,. ,: <br /> Signature , , � • : , <br /> - M Company Registered Y / N I ..Fee. Current 1,-. ; Y / N.; I <br /> i <br /> Address I , <br /> I License # <br /> PLUMBER - Company <br /> Signature Registered Y[ N I Fee Current' I Y/ N <br /> • Address I <br /> 1 License # • ` _ j <br /> MECHANICAL I Company I <br /> Signature I Registered Y/ N j Fee Current I Y/ N <br /> - Address 1, :;: , • <br /> 1 License # <br /> • <br /> OTHER Company <br /> Signature Registered Y/ N J Fee Current I Y/ N j <br /> Address <br /> License # <br /> Directions_w <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 (httpf /appraiser.pascogov -com) <br /> • <br />