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. $1 -780 -0020 City of.Zephyrhills'Fire I Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 3/ / f o Phone Contact for Pernik ( 3 ( 3 <br /> ... _scu�...ltc kia;� ... a :;.'G......,..,...: ...,.. _......... . <br /> Owner's Name �eP /41 /t. C_0 1 4 : 1 -1-4, -N S Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 7 & l 0 G 4-u_ 64,G/ O S s -Oa-O Lot# <br /> Sub Division Parcel # <br /> I Bio -Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct 1 Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I Hood Installation <br /> Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw 1 LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> t(ltrlyl !Semi] MUll Other <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers <br /> Hood Cleaning n ❑ El ❑ I 1 � Sprinkler System Installations -- /� C cUM2 k <br /> Hood Suppression n E-1 ❑ ❑ I I n , • <br /> Standpipes (Sprinkler Sys) ' <br /> I - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I I Valuation of Project (, ! I <br /> I I Fuel Tanks f41• a11CW. 3131/ <br /> n Other: I �. <br /> +.�xwa',:ntwR ,�Y'i;: -SG#_ ...: ^s\ t 3tt.Y - :5'� s vr«. .5 v. �., x,+..'.im ..s�.;_ ,... ... .: ... . ..... .... ry.�lc re —. a . _,.:,:x .. ..+t'rsLae">2 %S".5 x3F."�. '?N.:$t1 ';�;' .- c- ..l— n:':.a ,. Yu'.. —Rd .t..' ` Ma•` ti <br /> Contractor i��� _✓✓„ f /4___—______ Company n D U s iYl.es <br /> Signature �� �� �' S -a > � Registered Y / N I Fee Current I Y / N <br /> Address 1 1 License # /404 -¢ c /'2[79 <br /> ELECTRICIAN Company <br /> Signature Registered _ Y / N I Fee Current I Y / N <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current 1 Y/ N I <br /> Address I • License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current Y/ N I <br /> A d s dress j . License # <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 52500, 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: /lappraiser.pascogov.com) <br />