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530u <br /> 813-780-0020 City of.Zephyrhills Fire 0 /' b ZZ <br /> Fax - 813-780 -0021 <br /> Permit Application <br /> Date Received <br /> P one Contact for Perm <br /> �.:•,��a .. :.Y .: a. <br /> Owner's Name Z Pi-ri hI-4( LL S (A ) pa r Owner's Phone Number ) I I <br /> Owner's Address I <br /> Fee Simple Titleholder Name Titleholder Phone Number l I <br /> Fee Simple Titleholder Address <br /> Job Address LI 3 3 0 D 7-11 S i R f ■ Pei `f R ("k I -k. ,s 1^ L _ 3 3 53' . Lot # <br /> Sub Division Parcel # <br /> Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum n Hood Installation <br /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> iUtrlyI !Semi"' (ai Uther <br /> Sprinkler ❑ ❑ ❑ 17 Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 Sparklers <br /> Hood Cleaning 17 ❑ ❑ ❑ 1 I 1 Sprinkler System Installations <br /> Hood Suppression I Standpipes (Sprinkler Sys) <br /> FT Fire Alarm Installation n Torch Roofing/Tar Kettle , <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ) •I Valuation of Project <br /> Fuel Tanks <br /> Other: I <br /> Contractor <br /> 7/Y / - -- Company 54 f `( f fQ)h/ A/ Af Signature � S� t7 ✓S <br /> Registered Y/ N _ Fee Current I Y / N N <br /> Address I 1 License # <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I I License* <br /> PLUMBER Company <br /> Signature Registered Y/-1\1 j Fee Current I Y/ N <br /> Address 1 1 License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current I Y/ N j <br /> Address License # I <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current I Y/ N j <br /> Address <br /> 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 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br /> • <br />