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813- 780 -0020 City of.Zephyrhills Fire �_. - Fax-813-780-0021 <br /> Permit Application <br /> Date Received 7 4-a l(/ J Phone Contact for Permit <br /> A 'a � i.,:i.a z...•.,_. .,.r,.,_ ,.� ti <br /> Owner's Name Iy /An I I f j - l - 6o /-r,M ow L. Owner's Phone Number <br /> -- Owner's Address 11Z ' Z C (; f_c (l 1 lfC9 - <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> >,:�.�'�.......a..s ..zaoomm z,a.mwmo": , „N',v.c - .. . �P. �;ta��a iii .�.p�.;� - �'!:' • ��.�^..?�: � '.�?O,, a..:"�-'� H�'�._ ��..x.':�w...�..�M..>.a..:_� `Tt E.�.�......:: '.... .. .,t: + <br /> Job Address K� S /2 G.0,I 1 BIVA - Lot# <br /> Sub Division Parcel # <br /> ...,te.w M'or.Nu:: °t.,'"vkoommaa%ziuw4k. 5,.E " "fie wr . o."^ d.. TWO ' ak:..:.aea. ," a"MXZA' N.. 3, . t.:3a ...S rngrk0.,aur' M .E <„W ; :. :1;, w.. 5r ...<y..R.,.ZYKI :t <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n C - ontrolled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw ; , .- LP /Natural- Gas - ANNUAL Sale <br /> El F ire Protection Maintenance - ANNUAL Places of Assembly - ANNUAL _ <br /> �QtrlyI I Semi I t I ram <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum / �(� <br /> Fire Alarm 0 El ❑ I I I I Sparklers / <br /> Hood Cleaning [ ] ❑ ❑ ❑ I I n Sprinkler System Installs ons <br /> Hood Suppression El ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> I - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> F ire Works <br /> n Flammable Application- ANNUAL ( I Valuation of Project <br /> n Fuel Tanks <br /> El Other. I I <br /> omeatoon,m.. acxx, umos.,:zm3.. <.s..�.�t,.- .aw s' :.: -' . ea':�., - amatmoawu°'.ct....:3LLmokro'e:,:'.. -e.. , 3Wata5�,Hs'`.,.,M.�.ZIMa.aM- .EMEccerW,uEM liraMt <br /> / Contractor Company V I <br /> Signature V- (`�,,,,_1 Registered _ ¥ / N J Fee Current I Y/ N I <br /> Address I ( License # I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N I Fee Current I Y / N <br /> Address I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address License #1,z2j a.�a.e�:a�..aa.�m.�..o.�. <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 />