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q��v <br /> Fax- 813 -780 -0021 <br /> City of,ZephyrhillsFire <br /> s1 7saoazo p e �i{ gpplication <br /> Phone Contact for Permit 7 Z7 - 4 AI XIM <br /> D Receroed ,; no <br /> � w A te- - .� e ND Q `e. A / / 5 Owners Phone Number <br /> 1 I l <br /> Owner's Name <br /> Owner's Address i � 7 � , l s ft., <br /> It-d _ Z e A ' �� � <br /> �^ Titleholder Phone Number <br /> re <br /> Simple Titleholder Name <br /> Fee Slmp � � - <br /> SmpteTrttehoe Add .,.._ ,x • .....' . ,. ._ ■_. ., .e .•'.....::' <br /> •. . . .��"°: ta..... z ,...x...., _ ..... <br /> M`. �' 'A' 2 �u .si ": "i+l lu .f'v: <br /> ;-cd <br /> i � *�.w.Yr.��,.r .�.,.., ..,:. km 4/ //s. �L Lot r <br /> Job Address <br /> Parcel # <br /> Sub Division <br /> Waste Storage- ANNUAL = g <br /> uµ,•,ca,. Fumt atloTent <br /> l I Bio-HaLard Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct (— Hood Installation <br /> - Controlled Burn 1-- <br /> LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw = LP /Natural Gas - ANNUAL Safe <br /> i j Emergency on Mai ten nc kw = Places of Assembly- ANNUAL • <br /> L j Fire Protection Maintenance = A' L. tr y] ner <br /> 0 0 0 E Recreational Bum <br /> Sprinkler <br /> [asu e 0 0 <br /> C Sparklers <br /> 0 0 C Sprinkler System Installatio <br /> Hood Cleaning rinkler Sys <br /> Hood Suppression <br /> 0 0 Standpipes (Sp <br /> 1 <br /> Torch Roofing/Tar Kettle <br /> Fire Alarm Installation <br /> • <br /> Waste Tire Storage ANNUAL <br /> Fire Pumps u <br /> I 1 Fire Works Z o ® — Valuation of Project <br /> I I Flammable Application - ANNUAL <br /> 1I Fuel Tanks <br /> I Other: f <br /> Company [Ql G <br /> Contractor ��,��� Registered Y / 7v Fee Current <br /> Signature Xliii ,h � i7��Z j <br /> L f 70 / O74IC- f -�41,1- Atiii / 7 j D/i, -L- License # 1 <br /> Address / <br /> Company <br /> ELECTRICIAN <br /> I Registered Y / N Fee Current Y/ N <br /> Sicnature JI <br /> License # <br /> Address <br /> Company <br /> PLUMBER Registered Y/ N 1 Fee Current 1 Y/ N <br /> Signature <br /> License <br /> Address 1 1 <br /> Company <br /> ME CHANIC ALI Registered Y / N 1 Fee Current L Y/ N <br /> Signature 11 <br /> Address I •License# <br /> 1 <br /> Company <br /> OTHER Company Y / N Fee Current Y/ N <br /> Signature <br /> Address y f License <br /> Directions: a,_ <br /> 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 Parcel # - obtained from Property Tax Notice (http: /lappraiser.pascogov.com) <br /> Allow 10 -14 days for review after submittal date. <br />