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813a80-0020 City of.Zephyrhills Fire <br /> Permit Application Fax- 813 - 780 -0021 <br /> Date Received <br /> " ... ,w,, -, Contact for Phone orPerrrnt � „.;,� <br /> Owners } .R.?OS ILiStsy. Zr lfc� S�r'N _ ,... .A.,.,.. <br /> Name <br /> T Owners Phone Number 1 /3 112P I7 I ?O zp I <br /> Owner's Address Sa/ 7 Goo - Lc- '3L Vb ,Z,e // AL. I <br /> Fee Simple Titleholder Name I I 1 I I <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> :;, 5 ai, a E ,. GE M a : 5 . k C a w. <br /> I ` 1�9.'.” �k ,..,e.:iY:'aa,&;*�...x :a.;. ,�.,s".3..,,:..3i; <br /> Job Address I <br /> I Lot # <br /> Sub Division I Parcel # I <br /> m <br /> Bio- Hazard Waste Storage - ANNUAL h <br /> f I Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> n Emergency Generator < 30 kw <br /> LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw = LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL <br /> 1 ' Places of Assembly- ANNUAL <br /> IQtrly� emi �iR l Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I <br /> Sparklers <br /> Hood Cleaning ❑ ❑ ❑ <br /> Sprinkler System Installations <br /> Suppression Hood Su �, I <br /> pp EZ ❑ X ❑ I I n Standpipes (Sprinkler Sys ) <br /> Fire Alarm Installation Torch Roofing/Tar Kettle <br /> n <br /> F Fire Pumps = Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I 1 <br /> F Valuation of Project <br /> Fuel Tanks <br /> 0 Other: I <br /> w. � ?c ex's MITM "S€x:? ATZMAZE T EMLIMMIZZEMSa3 a�.4 > -;. <br /> -. ' ' - NMA..'D ,., . - t,. �"` ',. ...".: ..��:> °.;' ' •::< z':: zraT { <br /> Contractor ._��.:_; <br /> Signature I Company I <br /> Registered I Y/ N I Fee Current 1 Y N <br /> Address <br /> I License # I <br /> ELECTRICIAN <br /> Signature I I Company <br /> Registered Y/ N I Fee Current I Y/ N J <br /> Address I <br /> PLUMBER License # I I <br /> Signature Company <br /> I Registered Y/ N I Fee Current I Y/ N I <br /> Address <br /> MECHANICAL <br /> 1 License # I <br /> Signature Company I <br /> Registered Y/ N . 1 Fee Current 1 Y/ N <br /> Address <br /> OTHER I License # <br /> Signature I Company -Seeurrr ,C E me LZe I <br /> Registered Cy/ N I Fee Current I ('i N I <br /> Address <br /> .. k�... ,tea ..�.. , License # j: <br /> /99. <br /> e <br /> Directions <br /> �. ca � , a">1. :, > aar.&eva�.u�, :�a: s €�' per ,. -.=�Ea ., <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 (http: / /appraiser.pascogov.com) <br />