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i <br /> 020 City of.Zephyrhills Fire 1 i Fax -813- 780 -0021 4 -Permit Application <br /> Date Received - a - a Phone Contact for Permit ,' / -24 v <br /> Owners Name I r/ RS 1 C)4 v ,4Grf 0 F '-M ,'b j, SG,'e,n f f I Owner's Phone Number I S 13 17 &J'- 1a J-13. ‘f <br /> Owner's Address v So 3 4 4J e vi ' -ti 8 Fee Simple Titleholder Name Titleholder Phone Number U y3 - 70"J- � y <br /> Fee SimpleTitieholder Address <br /> s t <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Ti Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RO Facility) ANNUAL <br /> Controlled Bum = Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> em umEli rai Other <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm 0 ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning E ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I 1 1 Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> H Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL l ( Valuation of Project <br /> Fuel Tanks <br /> 0 Other: <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N j <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N J Fee Current I Y/ N 1 <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N . 1 Fee Current I Y/ N I <br /> Address I I ' License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address 1 I License # <br /> OTHER / 4 Company <br /> Signature ` �/V �"r i �+".� Registered Y / N . 1 Fee Current 1 Y / N i <br /> Address I License # <br /> Directions: i <br /> • <br /> • <br /> FIII 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 (httpJ /appraiser.pascogov.com) <br /> • <br />