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ati�-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received �_��� _ - Phone Contact for Pertnit � � .� <br /> Owner's Name s � Owner's Phone Number ��3 J'�� � <br /> Owner's Address � E � •ll /—'�. <br /> Fee Simple Titleholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> ;a . ,.,,:w.d�i�=.�.�-. � .... ,.,yr. .. ., <br /> Job Address Lot# � <br /> Sub Division Paroel# <br /> a Bio-Hazard Waste Storage-ANNUAL � Fumigation'Tent ' � $ `� <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier 11 or R Fa ility A AL <br /> � Controlled Bum � Hood Installation -. ' <br /> � Emergency Generator<30 kw � LPlNatural Gas-installation '�-��� <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale °�'�n ) � <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL /�J��e:�:���'`v �� <br /> �y emi �n er � � <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> �- ,�e <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers � <br /> Hood Cleaning � O ❑ ❑ � � Sprinkler System Installatio ���`~\ `� <br /> HoodSuppression � ❑ � ❑ � � Standpipes(SprinklerS ) �j�iy/►Q ,,���� '� <br /> P _�jC F%"`�`- � <br /> � Fire Alarm Installation � Toroh Roofing/Tar Ke ,� ,, ,�A� ' �', <br /> � Fire Pumps � Waste Tire Storage UAL I1 y�� ������1 p� <br /> � Fire Works �� � /�(} <br /> a "' <br /> Flammable Application-ANNUAL Valuation of Project <br /> aFuel Tanks ��' <br /> Q Other: -- <br /> Contractor Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature � Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Sig�ature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICA Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER Company �. � .,.r'� GG� <br /> Signature Registered N Fee Current �/N <br /> Address License# S"'$rZ7 / <br /> Directionx i � j� <br /> Fill out application completely � /1�`"""''''''��� <br /> Ovmer 8�Contractor sign back of application,notarized(Or,copy of signed contract with owner) � d J <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) �/i � <br /> Supply two(2)sets of drawings with applicable documentation � <br /> Allow 10-14 days for review after submittal date. Parcel obtained fro T ice(http://a raiser.pascogov.com) <br /> i � <br /> � <br /> . -- � ll <br /> i� <br />