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F? 3- 780 - '1020 City of Zephyrhills'Fire 7 Z 2- Fax-813-780-0021 <br /> Permit Application <br /> )ate Received - Phone Contact for Permit 3 2 .-107 <br /> Soya <br /> )wner's Name , 1 S* eel') e h SS t ie bJ{ D� f Owners Phone Number 1 si j 1 h a <br /> timers Address 1 53 5 3 5+v r i• Ze t+ t I s ' / 3 3S C.� <br /> . • J/ <br /> =ee Simple Titleholder Name Titleholder Phone Number <br /> =ee Simple Titleholder Address <br /> Job Address 3 6+k- t.-.-.,.. - I a + S 5 _ Lot # <br /> Sub Division EIMLI i I LIMILlM Parcel # — A.,# '7 0 `" 0976 <br /> El Blo-Hazard Waste Storage - ANNUAL = Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> a Controlled Burn Hood Installation <br /> F - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw LP /Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> •; (Semis (;j LAM' ri <br /> Sprinkler In ❑ ❑ ❑ n Recreational Burn <br /> Are Alarm ❑ ❑ lf I I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression Ej ❑ ❑ ❑ I 1 f -1 Standpipes (Sprinkler Sys) <br /> D Are Alarm Installation n Torch Roofing/Tar Kettle <br /> B Fire Pumps a Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application - ANNUAL ` Valuation of Project <br /> Fuel Tanks <br /> El Other I <br /> '. k.:. a.;.: iu -: . _ Y.. f: ... ,r ..c �— ..,.., ._r i. .._,�I.• rr.�✓.'_ -. ,v_.. <br /> Contractor i'7 - 1�� / �J' Company L. = 10k. dell C... . �iC. <br /> Signature Registered Waal Fee Current 41i7 N <br /> Address • A.' ► - . , ' License # 1E, F (o (E y Ler I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Curren Y / N <br /> Address I License # I I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y/ N I <br /> Address 1 ( License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N 1 <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address L icense # ( I <br /> Directions: <br /> Fill out application completely. <br /> Owner 8 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:l /appraiser.pascogov.com) <br />