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i (G 1 <br /> 813,780 -0020 City of Zephyrhills - Fire <br /> .. ' Permit Application Fax- 813 - 780 -0021 <br /> Date Received i <br /> Phone Contact for Permit <br /> Owner's Name I � F ��� <br /> �r ,E& tt/iS I Owners Phone Number I f73 I - 71.5" U <br /> Owner's Address 1 3g-2.4,1 / / ,, / -r-° /}v <br /> Fee Simple Titleholder Name i <br /> Titleholder Phone Number I I I <br /> Fee Simple Titleholder Address I <br /> t ». <br /> ....� �....''� _.�: -art "x� m .:d;f4 �.,sr;. ,: :. ,, _ -_ _.. <br /> Job Address <br /> r: <br /> Sub Division I <br /> I Parcel # <br /> . s )';:=4,...,..,.r •: «.. .«.:x..k�:.:4AV,,r « wf ,.Nre...l. Yv4 ik +' ... a ..::;.:_ <br /> I ..... w:.:: .. ._....a:: <br /> Bio- Hazard Waste Storage - ANNUAL "" `' "' <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> 1 Controlled Bum I Hood Installation <br /> Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> mergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL <br /> Places of Assembly- ANNUAL <br /> JQtriyI 'berm' JAnl 1 !Other 1 <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm I I ❑ ❑ taxi I Sparklers <br /> Hood Cleaning I 1 ❑ ❑ ❑ I <br /> 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Fire Pumps I Waste Tire Storage ANNUAL <br /> I Fire Works <br /> I 1 Flammable Application - ANNUAL I <br /> Valuation of Project <br /> Fuel Tanks <br /> Other: I <br /> Contractor - ,•,,.,__._,__ <br /> Signature Company '�/3h/t(` C3J <br /> Registered Y / N j Fee Current I Y / N <br /> Address 1 I I <br /> License <br /> ELECTRICIAN <br /> Signature <br /> Company <br /> Registered Y / N J Fee Current I Y / N <br /> Address I <br /> PLUMBER I License # <br /> Signature <br /> Company <br /> Registered Y/ N Fee Current I Y/ N I <br /> Address I <br /> License # <br /> MECHANICAL I I <br /> Signature <br /> Company <br /> Registered Y / N j Fee Current 1 Y / N <br /> Address <br /> I License # I <br /> OTHER <br /> Signature Company <br /> Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address 1 I I <br /> w 3 ': 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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />