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813:780z0020 City of.Zephyrhills Fire <br /> Permit Application • Fax-813-780-0021 <br /> Date Received <br /> "' .• ..•.... Phone Contact for Permit <br /> Owner's Name C.�Iiil���L e�� I � . .� ,..� _ � �,.,....._.........,: <br /> Owner's Phone Number cr-1 Mil 2 <br /> Owner's Address 1 _ /Y Q,9- .27,. / 7 j <br /> Fee Simple Titleholder Name I 1 J <br /> I 77tleholder Phone Number 11111111 = <br /> Fee Simple Titleholder Address <br /> Job Address . .,_. ._ 1 <br /> I 1 Lot* <br /> Sub Division 1 <br /> Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL <br /> El Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material <br /> (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum <br /> Hood Installation <br /> Emergency Generator < 30 kw <br /> ri <br /> LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw <br /> LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL <br /> Places of Assembly- ANNUAL <br /> IQtrlyl !Semi, 'Other I <br /> Sprinkler ❑ ❑ ❑ <br /> ED Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I I I—I Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ I I n <br /> Sprinkler System Installations <br /> Hood Suppression 1 21 ❑ A ❑ I I <br /> ri J = Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation = Torch Roofing/Tar Kettle <br /> rI Fire Pumps Waste Tire Storage ANNUAL <br /> I Fire Works <br /> n Flammable Application- ANNUAL <br /> n Fuel Tanks 1 I Valuation of Project <br /> 0 Other: <br /> aMitenliNUSEME NESIONMEMENIZEINNIMBUNIENNUMV <br /> Contractor <br /> Signature Company <br /> Registered ) Y / N j Fee Current I Y / N <br /> Address I I 1 <br /> License # I <br /> ELECTRICIAN I <br /> Signature I Company <br /> Registered I Y/ N _I Fee Current 1 Y/ N <br /> Address I <br /> PLUMBER <br /> 1 License* <br /> Signature I Company <br /> I Registered Y/ N J Fee Current i Y/ N <br /> Address 1 <br /> I License* <br /> MECHANICAL' <br /> Signature I Company <br /> Registered Y / N Fee Current Y / N <br /> Address I <br /> 1 I <br /> License* l <br /> OTHER <br /> Signature \ I Company ;� gip T E swU - <br /> Registered mum Fee Current re <br /> Address <br /> License* • <br /> pU <br /> Directions: <br /> Fill out application completely. <br /> • <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 raiser.pascogov.com) <br /> ( ttP� PP <br />