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813-780 -0020 City of Zephyrhills Fire 4 O 15F ax -813- 780 -0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit I 11 I I <br /> Owner's Name ta 11 `le[I 141 1QILL11j.b _ Owner's Phone Number Iq 0 q L _J c 1 13 Z D <br /> Owner's Address OLt `ps /"� <br /> Sk • a n S te_ �T��� ‘0%))C.. • S - `[ . gW ! L <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address r �' 1 <br /> t A s �dN S2 4 ca t\ ' - 413- Lot# <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct Ei Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Burn n Hood Installation <br /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> jQtrlyl Isemil I""' 1 Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Burn <br /> Fire Alarm ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning K ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> 0 Fire Pumps n Waste Tire Storage ANNUAL <br /> I - 1 Fire Works <br /> E Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> n Other: 1 <br /> Contractor fit,t,t /, ) « `/10- <br /> / Company 0001-1CC i & l 5 ,, v/': C e <br /> Signature � Registered Y/ N I Fee Current Y / N <br /> Address ( 1 Lice nse # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address ( I License # <br /> PLUMBER Company I <br /> Signature Registered Y / N J Fee Current I Y / N I <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y/ N 1 <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I 1 <br /> Address I I 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 />