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813 - 780 -0020 City of.Zephyrhills Fire <br /> Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name I/-k ..-y - pi-..KE )E;i4.,1 Owner's Phone Number 5'73 17.3 J l G 79S.. <br /> Owner's Address I y6- �/9-LL 3�f/17 24',1// s "'L, I <br /> Fee Simple Titleholder Name Titleholder Phone Number I 11 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address Lot # I I <br /> Sub Division I Parcel # I <br /> I I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> EJ Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n 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 /> �Qtrlyi emi MI Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning I ^ I ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ® ❑ lil ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application- ANNUAL <br /> I - I I 1 Valuation of Project <br /> Fuel Tanks <br /> n Other. I <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N � Fee Current 1 Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N J Fee Current 1 Y/ N <br /> Address I ( License # I <br /> MECHANICAL' <br /> I Company <br /> Signature Registered Y / N . 1 Fee Current I Y/ N I <br /> Address I <br /> 1 License # I <br /> OTHER Com an <br /> Signature ' -,)-- P ed 1 7 J! F Fee c "- LLr? <br /> Registered r� Fee Current <br /> Address /833 LiFc%ravee' ?" )V e: fK_ 3�S' -?lo <br /> Dir eCtlOnS: I License # 7�y - p� <br /> „ ��. <br /> Directions: <br /> ,.a,= ,;�esak>Aa:� *, "a .. ^4•"_ x' :� ,• •,a.�„.... , s;s�.„�„ar' .nna,±.�.3a �„fna� -. a.,mc:,* : ,+:.5;�'$,.�ti��« <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 />