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813 -78 -002 <br /> City of.Zephyrhills Fire. •0 1 v -1 Fax- 813- 780 -0021 <br /> Permit Application <br /> / Phone Contact for Permit ! <br /> Date Received 1 1 f R TO L. `, .Fr. 8 / <br /> Owner's Name <br /> 4,021_62( �RVi19T7 I Owner's Phone Number �• q <br /> /99 � �f <br /> Owner's Address 17 • 0, BO' ` i 73 7 / FL 3367 <br /> I Titleholder Phone Number I I <br /> Fee Simple Titleholder Name <br /> Fee Simple Titleholder Address 'xis Lot* � <br /> �'. $`FF �.,.K�'.�1'i ..ik� cYss..x .,x'�v .�,.� ,,+ - .?`: - �`�' -�a'a -,.s,w� .- n <br /> ^a.� + " � fJi[.(/ <br /> I * L E /A/ CNE 2 101vW�'TS' 6.. <br /> Job Address <br /> Sub Division 1 I Parcel # I <br /> Bio-Hazard Waste Storage — ANNUAL 1 Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum 1 I Hood Installation <br /> Emergency Generator < 30 kw 1 I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I Places of Assembly - ANNUAL <br /> ❑ 1 IUtrlyl'SemiI rA�I !Other I <br /> Sprinkler ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 1 1 Sparklers <br /> Hood Cleaning // 41 ( ❑ I 1 1 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps 1 Waste Tire Storage ANNUAL <br /> Fire Works ' I <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Other: ,.w ,. „ � �<� <br /> - 4 ./11J���_� 1TIIS <br /> S ignatu re! G R egis ere Signature -� Registe Y / N Fee Current Y / N <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> PLUMBER Company <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 1 Y / N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered L Y / N I Fee Current I Y / N I <br /> Address License # <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 (httpJ /appraiser.pascogov.com) <br />