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813-780 -0020 -11/4355 City of Zephyrhills Fire .Eax - 13 -78o -ooze <br /> Permit Application <br /> Date Received 1167MBErallil Phon ;i� <br /> e Contact for Permi � 5S - 7 03 <br /> ..�::.:a, x�...,,. :. ".#:'3wZ"�.:";3s;r...xr >s• .3. ,::a €u ,...c�:s:: .. , s...�:... w.,,,...s...;a:: ,.�....,m. ,,. <,�..�....,.. <br /> I <br /> Owner's Name Tj,V - )vC. Oa /f1,0 ea ' Owner's Phone Number <br /> K z '3I d <br /> Owners Address �7`�S �ia 1) v I ph y r iotftt5 /... <br /> ( <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address (n 7 -f' I'S 6,411 . .. g ti / Z p /I i r A ; t ( 5 • t- t . 3 35 -f ^� Lot # <br /> Sub Division Parcel # <br /> N: s , ., ., ,e <.m ,?,em.a w ar y es,s.a iata:mw;Amm ma:' t °` mtoommw.T..SBBS:s . t tvrxw X • : ^`u ' , . k SYCmga?v' a roia..a rsta mwma.m u" Emammtesr <br /> El Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I 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 [7 Places of Assembly- ANNUAL <br /> lc/triv' 'berm' ma Other <br /> Sprinkler E ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> I in Flammable Application- ANNUAL I (S I olio I Valuation of Project <br /> Fuel Tanks <br /> n Other: I I <br /> Contractor / Company T : i-larf 1; IA e. .Vitt "'t 4 Z C <br /> Signature / / Registered ram Fee Current ram <br /> Address I I License # r= . 0 oO ( t7 O le I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address 1 License # I <br /> �:�os '� �. a!, ,... „..... yiast., �. d.,. ...,...�..s.•:�::,s�::y,�,w.,• "".sm- " °am€.•�z`��:.� ax»... �.... s; �. u: aww. �w�: ..�;:< >.....,._,� . �s�:,�.za.: a,.m ' .a"”' ^'r. <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 />