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813-780 -0020 City of ZephyrhillsFire. Fax-813-780-0021 <br /> Permit Application - <br /> Date Received - Phone Contact for Plant ficiMill I t ?� 6S� <br /> Owner's Nae r1 t;afvl�� �.��1 ar Owner's 1 i <br /> m Phone Number 1 - 1 1 1 <br /> Owners Address <br /> Fee Simple Titleholder Name 1 l Titleholder Phone Number ( I ( I ( <br /> Fee Simple 'Titleholder Address I <br /> Jo b Address r 4/ 1 v i Lot # ( <br /> Sub Division 1 Parcel # 1 <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> ri Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier I1 or RQ Facility) ANNUAL <br /> n Controlled Bum I 1 Hood installation <br /> ED Emergency Generator < 30 kw n LP /Natural Gas - installation <br /> n Emergency Generator > 30 kw t 1 LP/Natu al Gas - ANNUAL Sate <br /> a • Are Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> ILlag uemr ® Uther <br /> Sprinkler ri 0 ❑ ❑ 1 ` 1 Recreational Bum <br /> Fire Alarm LJ ❑ ❑ ❑ 1 I Q Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ I 1 1 1 Sprinkler System Installations <br /> Hood Suppression V t ❑ X ❑ I l ) 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Rooting/Tar Kettle <br /> 9 Fire Pumps n ire Waste T Storage ANNUAL <br /> Are Works <br /> H Flammable Application- ANNUAL 1 1 Valuation of Project <br /> Fuel Tanks <br /> Q Other. f 1 <br /> Contractor �' Company 'G - - 4 • T - F* "r.... M <br /> Signature Registered Y/ N Fee Current 1 Y / N f <br /> Address 1 I/ac 1 Cock. t cc .r r 43 toe- -- rc..i• ._ '(, I license # L /'63 z 1 coo /ate 9 <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N f <br /> Address 1 I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address 1 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current 1 YIN 1 . <br /> Address 1 I License # ;. - I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I License # ( I <br /> Directions: <br /> FPI out application completely. <br /> Owner & Contractor sign back of application. notarized (Or, copy of signed contract with owner) <br /> If over S2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Mow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpi /appraiser pascogov,00m) <br />