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813-780 -0020 City of Zephyrhills Fire -g I [ (, 4 Fax -813- 780 -0021 <br /> Permit Application le <br /> )Z Received 1 1 9 Z% C� Phone Contact for Permit 18) 3 11 S' 7 1 '1'60-71 <br /> Owner's Name {�J .. � � �aa��€r tea.. �..��^���� ��.�4�d�.•. .:«� .�,... . s. ,,. .� ., " �...�- M� . �,. .m, ....z.. � .,...��.. <br /> r (i L `- " F �� '(1 i N( Owner's Phone Number 1 1 l <br /> Owner's Address '6 1© C I A(2 2 t-'7 i ceP I -i I L4 Z 17 Z - 2_, <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> :z:, C,C.�. u, ..c, »naiWirSHA,i' ::;S°I;, d'"TMPSOM MVAPPWR' .:r, A . ... ; MONS r.g 2,,, e';& stg, NERMEC ,MMPEMet.. ,.. ""''. '"s' ai',d+,imi€ omali ..._ g,E itii atilt <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> . mom x z:L...:. mAmi mo- 4,,i, .. 4wmmoet u•. r�,�.� . "u Y" a ar ats w ..ci ":.m" ouar g. ..R' .,nzaeram mRc..: Y ".€ t'Rm:a..... t: a4aosga .:' milt, emmm . rwswa'd' ;}S.. ww.vaty <br /> El Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Controlled Bum n Hood Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I - ) Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> lUtrly1 'Sem i Other <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum y� <br /> Fire Alarm 71 ID 0 ID 1 n Sparklers <br /> Y' e 6.. <br /> Hood Cleaning n ❑ ❑ ❑ I 1 I , Sprinkler System Installations <br /> Hood Suppression Ej ❑ ❑ ❑ I I El Standpipes (Sprinkler Sys) <br /> I — I Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I Fire Pumps I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I Z 7 2 an , o ©I Valuation of Project <br /> Fuel Tanks <br /> 0 Other: I I <br /> Contractor Company .fit `� / N i <br /> Signature LJ / /4� Registered Y / N C r ' Fee Current Y / N <br /> Address 13t'4 E Pz+j - Aue_` ozvs, FL 33C,(A. License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N j Fee Current 1 Y/ N J <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I License # I 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 I Y/ N I <br /> Address 1 License # J <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 />