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. 813-780 -0020 City of Zephyrhills Fire <br /> ax -81., 780 -0021 <br /> Permit Application <br /> Date Received 11111/klig/11" Phone Contact for Permit 1 Q I 1 t q q <br /> Owners Name �cr-/ ,/- f ae-4 - 0 I ,� / 1 177K11/3? q <br /> 1� �it�L l I Owners Phone Number n / <br /> Owner's Address J saa 0 Ye/t � y 0t ?e fAxrh/#5 F/ 3 .5S Y/ p Fee Simple Titleholder Name ( / b / \ <br /> I <br /> Titleholder Phone Number I I I 1 <br /> Fee Simple Titleholder Address I <br /> Job Address 3 g 0 /l ex ( Pt at-4 r f /P F 3 3 5 Y) Lot # i <br /> r r I <br /> Sub Division Parcel # I <br /> D 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 /> n Controlled Bum n LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator> 30 kw n Places of Assembly-ANNUAL <br /> © Fire Protection Maintenance - ANNUAL n Recreational Burn <br /> IQtrly Semi) Mil Other <br /> Sprinkler ❑ ❑ 12 I 1 El Sparklers <br /> Fire Alarm ❑ .1( ❑ I I n Sprinkler System Installations <br /> Hood Cleaning D ❑ ❑ ❑ i I 0 Standpipes (Sprinkler Sys) <br /> Hood Suppression ❑ ❑ ❑ ( n Torch Roofing/Tar Kettle <br /> n Fire Alarm Installation I Waste Tire Storage ANNUAL <br /> I Fire Pumps <br /> EJ Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 ' Valuation of Project <br /> 0 Fuel Tanks <br /> ❑ Other: I <br /> Contractor Company A "T <br /> Signature (4.4 !- So Ion . re <br /> Registered Y/ N i Fee Current I Y / N l <br /> Address I 3531 VI ey,4,c o, Ra, I License # >` F0000 14 L4 I I <br /> ELECTRICIAN! I Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I License # I <br /> MECHANICAL I Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # <br /> OTHER I Company <br /> Signature Registered Y / N I Fee Current I Y/ N <br /> Address I <br /> I License # I <br /> 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 />