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813 -780 -0020 City of.Zephyrhills Fire J ( <br /> • �' l ( 0 5 Fax- 813 - 780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit r 'O r <br /> Owner's Name Owners Phone Number I ,-L5 ' , 1224 fJ 9 <br /> Owners Address I 7S 2'/ , •// f � L-� J <br /> Fee Simple Titleholder Name / Titleholder Phone Number I 1 1 1 1 <br /> Fee Simple Address I <br /> Job Address - i ‘41/ l/v Lot # <br /> Sub Division Z .'V Parcel # 1 <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I - 1 Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> I )Semi) MO Other <br /> Sprinkler ri ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning J] ri ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Suppression ❑ ' 1 ❑ n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> nI Other: I <br /> s .. .r. r, • 5-` x. i _, , Z „`frl <br /> Contractor Company <br /> Signature Registered Y/ N j Fee Current I Y / N i <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N 1 Fee Current I Y / N J <br /> Address I <br /> 1 License #. I 1 <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I I . License # I I <br /> MECHANICAL Company 1 <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address I <br /> I License # I <br /> OTHER o t A/4 / "n` �2 g e 62 . Co C ompany <br /> � <br /> Signature // ), Registered lY N I Fee Current I Y / N J <br /> Address / � . <br /> r c ,z irAgiri ag License # LrZ1- /.I / _fiaz.� <br /> �.; <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 h //a <br /> ( ttP� PPraiser.pascogov.com) <br /> • <br />