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813- 780 -0020 ( (/ I S <br /> City of ,7_ephyrhills Fire Fax-78 -0021 <br /> Permit Application' - :;p ? $ :"� , <br /> Date Received I 7-13-1(.4 I Phone Contact for Permit I7 7 7 I I gel 2---1 r <br /> Owner's Name I ZecAl‘vr f.2dtc.c,1 Ac 45 LLC I <br /> I Owner's Phone Number I II <br /> Owner's Address I 1 9.13 6 Cobbles - I - on e. - Dr. <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 7 3 3 l7tree S1c p t . `Dr. �i L-e_, MS I Lot # <br /> Sub Division Parcel # J� .25 -21 -Ora) - pp 3c0 - I <br /> El Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> Controlled Burn n LP /Natural Gas - Installation <br /> n E - mergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> El F - ire Protection Maintenance - ANNUAL n Recreational Burn <br /> (Qtrly I emi Fall "I Other <br /> ❑ Sprinkler ❑ ❑ ❑ n Sparklers <br /> V <br /> Fire Alarm 0 ID ❑ I I n Sprinkler System Installations N 1 - Z I <br /> Hood Cleaning 0 17 El 1 1 n Standpipes (Sprinkler Sys) G� .` 3c L. <br /> Hood Suppression 0 ❑ 1:1 ❑ I 1 n Torch Roofing/Tar Kettle P 2 <br /> I Fire Fire Alarm Installation ix e o ,) c P - n Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> (n Fire Works <br /> n F - lammable Application- ANNUAL ( q 74, 7.3 I Valuation of Project <br /> E Fuel Tanks <br /> n O ther: I <br /> Contractor / / / _ < Company )\ —] p 4-....\ d(.- 1..iciw 1,.G <br /> Signature ` Registered Y / N I Fee Current 1 Y/ N 1 <br /> Address 3148 fri 54e .j Qd --� <br /> Grp unspciv, L I License # E F 0000 144.4 1 I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( <br /> 1 License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I yin' I <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 />