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813 -780-0620 Jiii , <br /> City of Zephyrhills' Fire. f Fax - 813 -780 -0021 <br /> • Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name S TMPT,FXGRTNNELL Owner's Phone Number 813 626 5482 <br /> Owners Address 4701 Oak Fair Blvd TAMPA FL 33610 . <br /> Fee Simple Titleholder Name - Titleholder Phone Number <br /> Fee Simple Titleholder Address . <br /> ,y :i,': a. e ^. -N A., -,-..« ..tea .-,: .r I ..fs . sk. z..s"a•"s .' - ::3 51"^21. -,, <br /> Job Address <br /> 2.3 5 ` D � . u , 5 n-1/2- e r � - . , 3 5 o -FL l o s PI E-at ZeN rhil S Lot <br /> Sub Division Parcel # <br /> I ` Bio- Hazard Waste Storage- ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I . Controlled Bum I I Hood Installation <br /> I 1 Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I ,' Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> 'p Semi I ( L <br /> Sprinkler I4 ❑ ❑ n . • I I Recreational Bum <br /> Fire Alarm I 1 ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning I I O ❑ ❑ I I I I Sprinkler System Installations <br /> _ . . Hood Suppression I ❑ 0 0 I I I, I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle - <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL 1 1 Valuation of Project <br /> I Fuel Tanks • <br /> I Other: <br /> _ - : �. :. ,;, v ... ._ate - ,._ . ,,, . , , <, z, :, ,,, ;_ , <br /> Contractor Company 3 ( Y 7 ' ` K.p,,)•v'-G t( <br /> Signature Registered Y/ N 3 Fee .Current I. Y/ N I <br /> Address I I . License # I • <br /> ELECTRICIAN Company _ .. <br /> Signature Registered Y/ N 1 Fee Current ; ` : / N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N '1 Fee Current I Y / N I <br /> Address I I License # . ' I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I _:: • License # I I <br /> OTHER - Company . <br /> • <br /> Signature Registered Y/ N I Fee Current 1 Y/ N j <br /> Address License # <br /> r . . ...._ :. ..- -- -- -.. .- .. ----- - - -w- •- ._ .z :. .. r c - - ,�, — . - r ao, <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 fmm Property Tax Notice (http: / /appraiser.pascogov.com) <br /> • <br />