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• <br /> 313-780 -0020 City of Zephyrhills fire <br /> 44 ((o (/10 Fax-813-780-0021 <br /> Permit Application <br /> )ate Received Li • - Phone Contact for Permit <br /> I . <br /> )wner's Name ` 1 C.. r f. e. _-S u ATM R Owner's Phone Number ` / l 3 1 / d 74 1,?.././ / <br /> )wner's Address ` 1 7 st 3 9' G 1, U t� 2.., i/1'1 l l s , - L 3 6' 4/ d- <br /> . ee Simple Titleholder Name Titleholder Phone Number 1 1 1 1 <br /> :ea Simple Titleholder Address <br /> Job Address C � - Yr. .- Lot # <br /> r M1� <br /> Sub Division � i � � ' �" �. � S Parcel # _ -Odic) -v / 700 <br /> n Bb- Hazard Waste Storage - ANNUAL o Fumigation Tent <br /> Ej Comm Exhaust Kitchen Hood/Duct I Hazardous Material (Tier 0 or RQ Facility) ANNUAL <br /> El Controlled Burn n Hood Installation <br /> a Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL ! I Places of Assembly- ANNUAL E •; !semi Uther <br /> Sprinkler ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm ❑ ❑ if I I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ I ` a Sprinkler System Installations <br /> Hood Suppression E] ❑ ❑ ❑ I . I [J Standpipes (Sprinkler Sys) <br /> ED Fire Alarm Installation El Torch Roofing/Tar Kettle <br /> R Fire Pumps I Waste lire Storage ANNUAL <br /> Fire Works • <br /> Flammable Application- ANNUAL <br /> 1 Valuation of Project <br /> Fuel Tanks <br /> ri Other. I <br /> Contractor j)-- Company 7 4 �' t <br /> Registered j . = <br /> Signature �� 9 ��/� F Current Mal <br /> Address • ,Q . z,....„ :. • u 1 , , 7 License # litainfll 00 v la ° EM <br /> ELECTRICIAN i- 6'6 Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I 1 License # I I <br /> MECHANICAL Company <br /> Signature Registered Y 1 N I Fee Current Y/ N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address License # <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:l/appraiser.pascogov.com) <br />