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813-780-0020 City of Zephyrhills Fire 11 `P Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received I 1 Phone Contact for Permit 14 21- 11 1 l g q 3 <br /> Owner's Name Prd in, -I It t Pr. N butt S J Owner's Phone Number / 3 178o I 1 4 v . <br /> Owner's Address 6 7 / C^ U G f / f 2 /l �"/f if/ // 1 / - 3 j 3s 7 ‘� ` <br /> Fee Simple Titleholder Name / I I <br /> Titlehoider Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address <br /> Lot # <br /> Sub Division 11 1 Parcel # <br /> I Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier 0 or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood /Duct Ii Hood Installation <br /> I Controlled Burn I LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw Ii LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator> 30 kw I I Places ofAssemb:y- ANNUAL <br /> I CI Fire Protection Maintenance - ANNUAL EI Recreational Bum <br /> lQO ❑ <br /> IYI 'Semi' �n ml� 'O I <br /> n Sprinkler Sparklers <br /> Fire Alarm El ❑ ❑ ❑ J J 1 l Sprinkler System Installations <br /> Hood Cleaning CI [7 0 I I I J Standpipes (Sprinkler Sys) <br /> ❑ Hood Suppression ❑ ❑ ❑ I I I I Torch Roofing /Tar Kettle <br /> n Fire Alarm Installation 1 I Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> 7 Fire Works <br /> n Flammable Application- ANNUAL I I <br /> EI Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> Contractor <br /> I Company A -,- <br /> o�i �{io <br /> Signature <br /> Registered Y / N 1 Fee e Current Y/ N <br /> Address 3531 111015.1.0ne, I License # I qg 35 31(0 la oo z I <br /> ELECTRICIAN' I Company <br /> Signature Registered I Y/ N J Fee Current I Y / N I <br /> Address I I License # I <br /> PLUMBER I <br /> Signature Company <br /> 1 Registered I Y/ N I Fee Current I Y / N I <br /> Address I I I <br /> License # I <br /> MECHANICAL' I <br /> Company I I <br /> Signature Registered Y/ N, Fee Current I Y / N I I <br /> Address I I I I <br /> License <br /> OTHER <br /> I Company I I <br /> Signature I <br /> Registered Y N ] Fee Current L Y N <br /> Address I <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 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpl/appraiser.pascogov.com) <br />