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813 -780 -0020 City of Zephyrhills -Fire #08 1 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received 0 — 0 Phone Contact for Permit Ei 33 73'3 <br /> Owner' Name fr L-- e l . G l [..L a- Owner's Phone Number <br /> Owners Address <br /> Fee Simple Name Titleholder Phone Number <br /> Fee Simple Titleholder Address J <br /> /� ` <br /> Job Address `� g 5(9 G r LV p — A/,1- i ' S (..ter QuA2- Lot* <br /> Sub Division ) M{(-- Co /4/1(Q /L s Parcel # <br /> 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 /> F - 7 Controlled Bum n Hood Installation <br /> I —I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ILttrly1 JSemi1 FAT1 uttter <br /> Sprinkler n ❑ ❑ ❑ ( ( Recreational Bum <br /> Fire Alarrn n ❑ ❑ ❑ I n Sparklers <br /> n Hood Cleaning ❑ ❑ ❑ I ( Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL 1 431090-00 I Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor /J /� Company Cc7 . OG' 7 iZI /ES <br /> Signature �"'� - Registered (s N . 1 Fee Current I CP/ N <br /> Address I e441 r 4- z/sl4,7 Di. t -7--",.)4,404 l '? c. /g I License# /4 r .;f / <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address 1 I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N, <br /> Address I I License # J I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N j <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y/ N . 1 Fee Current I Y/ N i <br /> Address <br /> License <br /> Directions: <br /> .. <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 - days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />