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813-780 -0020 City of Zephyrhills Fire <br /> Permit Application Fax- 813 -780-0021 <br /> Date Received <br /> ,:_. �� �.�,�.r.�:� � ...ar��N ...,,z �k•.:.. s, ��• � Phone Contact for Permit <br /> Owner's Name I Za ray, ( 4,,,,..7r� /�76-44L ('e,../ 7r.or I Owner's Phone Number I $ / 3 1 1 I 1 9' I <br /> Owner's Address 17J Z 2,0. y iopd 2r#4 A ,CC. <br /> Fee Simple Titleholder Name I I I <br /> Titleholder Phone Number I 1 1 1 1 I <br /> Fee Simple Titleholder Address I <br /> Job Address I Lot# I I <br /> Sub Division I I Parcel # I <br /> Bio- Hazard Waste Storage - ANNUAL <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> I Emergency Generator < 30 kw = LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw = LP /Natural Gas - ANNUAL Sale <br /> E Fire Protection Maintenance - ANNUAL � n Places of Assembly - ANNUAL <br /> n JQtrlyl !Semi( t Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning I ►� ❑ ye ❑ I I I�' � <br /> I I I Sprinkler System Installations <br /> Hood Suppression I �( ❑ - ❑ I�I <br /> n I I Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I <br /> F-7 Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor , ,,, u , ; , <br /> Signature I I Company <br /> Registered I Y/ N J Fee Current I Y/ N <br /> Address I I <br /> License # I <br /> ELECTRICIAN <br /> Signature I Company I <br /> Registered I Y/ N J Fee Current I Y/ N I <br /> Address I ( I <br /> License # I <br /> PLUMBER <br /> Signature I Company I <br /> Registered I Y/ N I Fee Current I Y/ N I <br /> Address I ( I <br /> License # I <br /> MECHANICAL' I <br /> Signature Company <br /> Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I <br /> 1 License # <br /> OTHER <br /> Signature �� I Company _ `ov ' ; ,ye EQvip...m/7- IL( <br /> Registered MUM Fee Current ► N <br /> Address <br /> J - 1 . � F License # I��.feff�ar74YPf6 <br /> Directions: <br /> Fill out application completely. d: . s s ° r. a :•.a <br /> , sU�- ::.Yi„a. <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 htt //a <br /> ( P� PPraiser.pascogov.com) <br />