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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 '' .e7.. %.,c/ Owner's Phone Number 1 8 I I 7.2' I 19 <br /> Owner's Address 1,57.L.2 7 gne, - azi/i) 2,9917 A /2, <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 1 1 1 I <br /> Fee Simple Address I <br /> Job Address <br /> Lot* I I <br /> Sub Division Parcel # <br /> _`a..M''€`.`,.,.: .. „a.'?.'a€�;�`.aY.. ,,. ,<,. s. mss'” ": Su.''a, - • -� I <br /> $3a:.,. INUiit s 'aia1 M:disC- s ew'...:a.•: , ..Z:laVrlk:MaiMSSVK;`. <br /> El Bio -Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL n1 Places of Assembly- ANNUAL <br /> )Utrly) (Semi) f� Other <br /> Sprinkler ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning R. ❑ A ❑ I I [ ] Sprinkler System Installations <br /> Hood Suppression ❑ 3 4 ID I I� Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation r---1 Torch Roofing/Tar Kettle <br /> Fire Pumps IJ Waste Tire Storage ANNUAL <br /> I - 1 Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> Fuel Tanks <br /> 1 Other: I <br /> Contractor Company <br /> Signature Registered Y / N ] Fee Current I Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature I Registered I Y / N j Fee Current I Y / N j <br /> Address I I License* I <br /> PLUMBER Company I <br /> Signature Registered I Y / N j Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature <br /> Registered Y/ N J Fee Current I Y / N <br /> Address I I License* I <br /> OTHER Company <br /> Signature�� I P Y !'irl7 � ,ce En?v :ar�n! i LL <br /> Registered MIMI Fee Current ei/ N <br /> Address I /,--z:o 41..,.., -"4 - e ,? ),, t'7 f-( ST-z <br /> iP ,- ,.,, y, .,. A ..,., 0 ,, , e 4 3 <br /> License* I a h.. d�Ohc�� /9g <br /> ,:. , . I <br /> Directions. �, a �,�,��•- �.�w. -� <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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />