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813-780 -0020 City of Zephyrhills Fire - 1' ([! " Fax- 813-780 -0021 <br /> Permit Application l <br /> Date Received I I Phone Contact for Permit IrtMli 1 y2 / 1 1 cg6 C) 1 <br /> Owner's Name I! Y e h \i -as /4, AMA / I AJ L I Owner's Phone Number I 11 1 I 1 <br /> Owner's Address I L 1330 0267 ,ST 21- 70 ' PL 5.35 <br /> Fee Simple Titleholder Name I I TTbehotder Phone %amber I 1 1 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address 19330 l Y\-- 5r 2 1" 1 l 14 ► I' LL..5 FL 335 I Lot# I <br /> Sub Division I I Parcel* I - I <br /> ET Bio-Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RO Facility) ANNUAL <br /> Q Comm Exhaust Kitchen Hood/Duct El Hood Installation <br /> a Controlled Bum 10 LP/Natural Gas - Installation <br /> n Emergency Generator < 30 kw n LP/Natural Gas - ANNUAL Sale <br /> IN Emergency Generator > 30 kw ED Places of Assembly - ANNUAL w ' , <br /> :CA Fire Protection Maintenance - ANNUAL Recreational Bum �CLnGc�Urz'Cl <br /> ED ® ® ® 'Other <br /> Sprinkler ❑ ❑ ❑ El Sparklers �� "` " QAµ " <br /> Fire Alarm ID ❑ ❑ ❑ I 1 Sprinkler System Installations �' " `' <br /> Hood Cleaning El ❑ fin ❑ I El Standpipes (Sprinkler Sys) <br /> bieartSuppression El ❑ !m' ❑ 1 + EJ Torch Roofing/Tar Kettle <br /> ED Fire Alarm Installation V \ n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> Valuation of Project <br /> Fuel Tanks <br /> ED Other: I I <br /> Contractor / , a0 <br /> Vol / J 1 /+ Company lft , _ L £t P 17'. •.� <br /> Signature J `_S'C, � / V / <br /> Registered non Fee Current "Mal <br /> Address 112oc I Ali :'fii room N ?-", i'L S.E, 1J. 1% L 317/6' License # I ?COL. aMO/WOO I <br /> ELECTRICIAN Company I <br /> Signature f Registered I Y/ N 1 Fee Current I Y/ N 1 <br /> Address I <br /> I License* I 1 <br /> PLUMBER 1 Company <br /> I <br /> Signature Registered I Y/ N 1 Fee Current I Y/ N I <br /> Address 1 <br /> 1 License It 1 <br /> 1 <br /> MECHANICAL 1 Company I <br /> Signature Registered I Y/ N I Fee Current I Y/ N 1 <br /> Address ( I License it I 1 <br /> OTHER 1 m I <br /> Signature Regis I Y/ N . 1 Fee Current I Y/ N I <br /> Address I I License* I 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 wlth applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel t - obtained from Property Tax Notice (httpi /appraiser.pascogov.com) <br />