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813- 780 -0020 w City of.Zephyrhills Fire �/ I0 1 (I k Fax-813-780-0021 <br /> Permit Application . <br /> Date Received I 7 ti -10 1 Phone Contact for Permit 1//3 1 9f4 I 14q69 <br /> Owner's Name A ' I I I <br /> Owner's Phone Number 1-1 <br /> Owner's Address C r 3 6 C,- r , 3 Z <br /> Fee Simple Titleholder Name I 1 I 1 1 1 1 <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> i': . x..?.,.itt ,Zak MIE M M «' - . UM= ....„. .:.> .: td A..awra ',s var .. mr > - <br /> Job Address I _ D 3 G I(,- n t r 3 3 sr-- 'T 1 <br /> I I Lot # I <br /> Sub Division 1 Parcel # I <br /> ^M a< s �.:s; .nt .�,.szearallz "'� =101 k i ;..: ,l .e"d�; r ems. ionsii,'.' ". Timis .gagAv�':x".mitxt 'Z aviAm,. .4 & tai imiii'F� <br /> n Bio -Hazard Waste Storage - ANNUAL " "' <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> n Emergency Generator < 30 kw El LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw = LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> 1Qtrly1 1Semil J 'Other f <br /> Sprinkler ni ❑ ❑ ❑ I n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ❑ �f ❑ I I = Standpipes (Sprinkler Sys) <br /> n F ire Alarm Installation /` = Torch RoofingrTar Kettle <br /> n F ire Pumps = Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n F lammable Application- ANNUAL <br /> n 1 /00 -- I Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> ,i,Mt,MVAIIIMIMMEZEMS MEMEMONIERHardiSiNiereaSaVA, 0 ::44,.. % . c":u3". : =£;a .�s:r<: - "�.'.:�.a+am .s:aa. a"...e*:= v: � I <br /> Contractor <br /> Com an I <br /> Signature P y �%'>: 4 f+ a�' RG <br /> Registered Y / N I Fee Current � � Y / N <br /> Address I /t ./w,r f- 0 t I <br /> License # I <br /> ELECTRICIAN <br /> Signature I Company I <br /> Address I Registered I Y/ N .. I Fee Current I Y/ N <br /> PLUMBER I License # I I <br /> Signature ! I Company I <br /> Registered I Y / N J Fee Current I Y/ N <br /> Address I I I <br /> License # <br /> MECHANICAL! <br /> Signature I Company <br /> Registered I Y/ N I Fee Current I Y/ N I <br /> Address I I I <br /> License # <br /> OTHER <br /> Signature I Company <br /> Registered I Y/ N j Fee Current 1 Y/ N I <br /> Address <br /> 1 '' License # <br /> Directions: <br /> :�:, <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 />