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813 - 780-0020 City of ZephyrhillsFire:�:- <br /> 1 b r a <br /> Fax- 813 780 0021 <br /> Permit Application <br /> Date Received r. Phone Contact Permit <br /> Owner's Name , Skp1 )101100 mob1k.. E' 1 ±t S Owner's Phone Number <br /> Owner's Address 38L S l ansirig Al e.nuL - 2phkl- ) l) FL 3351-2 <br /> Fee SimpleTitleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address F'V' (Qii9l(0 LtOi(Q. R , 7.eph )nJk TL 335'J2, Lot# <br /> Sub Division I Parcel # <br /> fl Bio-Hazard Waste Storage - ANNUAL fl Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood/Duct • IT Hazardous Material (Tier I1 or RQ Facility) ANNUAL <br /> El Controlled Bum I Hood Installation <br /> I - I Emergency Generator < 30 kw I LP/Natural Gas - Installation <br /> I - I Emergency Generator> 30 kw = LP/Natural Gas - ANNUAL Saie <br /> 17 Fire Protection Maintenance - ANNUAL - l ► i Places of Assembly - ANNUAL <br /> tun Ibemi I 1741T1 utner <br /> Sprinkler ID ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I . n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n SpdnklerSystem Installations <br /> Hood Suppression El ❑ ❑ ❑ .1 I ( I Standpipes (Sprinkler Sys) <br /> 1 - I Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> Fire Pumps F Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ) , Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor Company <br /> Signature -) Registered Y/ N 1 Fee Current I Y/ N J <br /> Address I ( 1 License # I <br /> ELECTRICIAN • Company <br /> Signature Registered Y/ N J Fee Current I Y/ N <br /> Address I I , License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y / N I <br /> Address 1 I .License # I <br /> OTHER Company <br /> Signature Registered Y / N . 1 Fee Current 1 Y / N <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 (httpJ /appraiser.pascogov.com) <br /> • <br />