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813 -780 -0020 City ofZephyrhills Fire- <br /> r61,- rex- oi riov -��ci <br /> Permit Application <br /> Dat+A'Received <br /> • for Permit s7 <br /> Phone Contact y (� ` 1 <br /> Owner's Phone <br /> 1700 v41EtJ itenNlt (....4.4. I -- <br /> Owner's Name <br /> Number I I 1 I l <br /> Owner's Address 1 12 j •OvitS).f011.0cC7 S T7}ygttS PAZA G4 4 4.34a pp I4DD92.. 1o Z <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 l <br /> Fee Simple Titleholder Address <br /> Job Address / 10(9 G Pte-C.- ra...V.D Z tEh1r02641u. Pt- Lot # <br /> Sub Division e rTh tiC ma c,. Parcel # 3S ZJ 7 1 ' Oib i O ' Q$,rpo • ape, <br /> ED 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 /> Ej Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> H n Emergency Generator> 30 kw <br /> LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> (LIf !Semi] Da' Uther <br /> Sprinkler I ] o ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I 1 n Sparklers <br /> I I <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression Ej ❑ ❑ ❑ ( I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> ' .00 Valuation of Project <br /> Fuel Tanks <br /> 0 Other: I <br /> WINNISIffifillin / <br /> Contractor S T - r <br /> ", Company laoppy. r-AttS 'SP2>,A 1I1L • I <br /> Signature 14111112 Registered Y/ N j Fee Current Y/ N J <br /> Address 1 License # I4 a ea bz.04,30119S' <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current Y/ N J <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N J <br /> Address I I License # I <br /> OTHER <br /> Company <br /> Signature Registered Y/ N j Fee Current 1 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 (httpJlappraiser.pascogov.com) <br />