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813-780-W20 City of Zephyrhills Fire "' ' 1 099 Fax - 813 - 780 -0021 <br /> Permit Application <br /> Date Received I 2 `f 10 <br /> ^. . Phone Contact for Permit �.. ::LS'` L' "Rk.. . wGa$s @F§i...X$o. Y u"�$. ..bY ... ss ya w'?n4�.. z w.bLL �..^. •,......aa, a.. I I .^ 1 k@ <br /> Owner's Name I Lc S 7C, - .1.1/ / Owner's Phone Number 813 9117 I I'S,/ <br /> Owner's Address I S / 7 640-1 71 i'L • 2,/l /r%<Y 14 33s <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address Lot # <br /> Sub Division I Parcel # <br /> d...0 `,% ittif A. .s'".:� .a'v' E A_ A '.s. . z +�a:. s '.:: .r'.. . -;.,. .::: -.• ..a ' d"�".71 eV M C ..roS . 41 442M3P : , " Va it ,SAIS .0„ 4t:"�kEfti=i3O <br /> n NU n Fumigation Tent <br /> Bio- HazarS1_WastcStorago R ACe_AL _,_ <br /> Comm Exhaust Kitchen Hood /Duct ' •\ ,, ) Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> -- - f;orrtrotleti• burn n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation i <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale ` f� < <br /> n Fire Protection Maintenance - ANNUAL n / Places of Assembly- ANNUAL " r <br /> IQtriyI'semii IATT1 Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum�1�— <br /> n Fire Alarm ❑ ❑ ❑ I I I I Sparklers ; <br /> Hood Cleaning n ❑ ❑ ❑ I L n Sprinkler System Installations <br /> Hood Suppression NI ❑ X ❑ I ✓I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> a Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> Flammable Application - ANNUAL 1 ( Valuation of Project <br /> n Fuel Tanks <br /> F —Other: 1Z SAM vP47 . 1F (J• L Sod s7 :44.1d f <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I License # I <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N j Fee Current 1 Y / N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N _I Fee Current I Y / N <br /> Address 1 I License # I <br /> OTHER Company 4 /7 ,.t ' d., -' ,_/ A z.L' <br /> Signature Registered wog Fee Current [QIMI <br /> Address License # 17 ��5`� _ OY��lG I <br /> > $i id 1,.' r. ^,,,,,,, - .�.,,amp.XV,R .M.M,Xd,tt ,_,.,....F ...wgwo. € .a.m..m�..........ws. , .k,,,Y. , n ^ - >' ` .a . - - ' ....a .. 4.44.#+z .a . ..+...«e ,...aa —com atom <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 />