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813-780-0020 City of Zephyrhills Fire 4 + CC 7 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received r ) f i` c7) 40 /O <br /> one Contact for Permit <br /> �._ ) 1173 l..' <br /> Owner's Name Owner's Phone Number I I I <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 1 I I <br /> Fee Simple Titleholder Address I <br /> .,:' . ,> . .,,, ?au. = 1, 3 ,`' ,,.: , .,, acn ..ss#; +a`'a , 3,: .e'1 �` zfi• <br /> ,x � <br /> Job Address 7 O / 0 Cj, l�/i<- irLV O _ (J �v <br /> C � .._a._ Lot# <br /> Sub Division Parcel # <br /> n .. ao- - u ..... 6 . - � .r...a;41: z1, .; au s1;;. ! ...,3, aa• .. <br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation lent <br /> n 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 I I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> lutriy) Semi' [ ?i 1 Other <br /> Sprinkler 7 ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 1.1-' Sprinkler System Installations <br /> Hood Suppression TI ❑ ❑ ❑ I I E) Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps In Waste Tire Storage ANNUAL <br /> Fire Works <br /> 7 Flammable Application- ANNUAL <br /> I (? u`L t) Valuation of Project <br /> n Fuel Tanks <br /> I—I Other: I <br /> B:::k.` ... x.....i.„ 1 & ?5M101=t1�.a•^'�.FMIEZS.IMMar ..K.. ra" `uM,In . kMVs tiVaZMWER ,` .:...cs. S.,'tgAa, ,..:,..] , I= -M U,:h :'%-,i : ) t:M ,, M. ; 4..:?,:t, <br /> Contractor Company C-4- 5GO riA.)C9v -ley j :Ax/L- I <br /> Signature I 4V N <br /> Registered 15 7 ) / <br /> / N Fee Current <br /> Address r�`1 -i`j / 11 04, I79llP4) l ) ?3 /7 1 License # /1 -5 01' <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N ] Fee Current I Y / N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current 1 Y/ N I <br /> Address I I License # I <br /> OTHER <br /> Company <br /> Signature Registered Y/ N I Fee Current I Y / N J <br /> Address I I License # I <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 />