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813 -T80 -0020 City of.Zephyrhills Fire <br /> 'Permit Application I (c Fax-813-780-0021 <br /> Date Received — - •- /p Phone Contact for Permit <br /> Owner's Name — Z{/ Q.97 ? rD4' 0�� s Phone Number 2 <br /> I / / � / � J � � Owner' Ph � 8/3 � ZoS � 0327 <br /> Owner's Address I 3 7 8/s 41 16e <br /> Fee Simple Titleholder Name Titleholder Phone Number I 1 1 1 1 <br /> Fee SimpleTitleholderAddress <br /> Job Address 37 P/5" /.Sd'i Ave <br /> I <br /> Lot # I <br /> Sub Division Parcel # I <br /> MEM <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 /> CI Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I Emergency Generator> 30 kw = LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> IQtnyl !Semi) Other <br /> Sprinkler ❑ ❑ �i n Recreational Bum <br /> Fire Alarm ® ❑ ❑ . I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> = Fire Pumps ED Waste Tire Storage ANNUAL <br /> n Fire Works <br /> FT Flammable Application- ANNUAL ) I <br /> Valuation of Project <br /> Fuel Tanks <br /> ( Other: I <br /> Contractor <br /> �_ / I Company <br /> Signature G(/ Registered I Y/ N � Fee Current Y/ N <br /> Address I <br /> License # I <br /> ELECTRICIAN <br /> I Company <br /> Signature I Registered I Y / N I Fee Current I Y / N J <br /> Address I I License # I I <br /> PLUMBER I I Company <br /> Signature Registered Y / N j Fee Current I Y / N I <br /> Address I I ' License # I <br /> MECHANICAL! I Company <br /> Signature <br /> Address I Registered I Y/ N . 1 Fee Current I Y / N j <br /> I License # I <br /> OTHER I I <br /> Company <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address License # <br /> Directions: <br /> Fill out application completely. <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 /> • <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 /> • <br />