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813-780 -0020 City of Zephyrhills Fire .1+ II 01 Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit 12 7• I I t g q 3 <br /> Owner's Name f f P Owner's Phone Number I g/ 3 I ri o c/ <br /> / y /� <br /> ,/ r/ 3 3 S y� <br /> Owner's Address 6 7/1 Par • Zflf!?t <br /> Fee Simple Titleholder Name 1 pd. <br /> Titleholder Phone Number , <br /> Fee Simpie Titleholder Address I I <br /> Job Address Lot # <br /> Sub Division I Parcel # [ <br /> n Bio- Hazard Waste Storage - ANNUAL ED Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> EI Comm Exhaust Kitchen Hood/Duct Q Hood Installation <br /> rip Controlled Burn = LP /Natural Gas - Installation <br /> El Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw = PI_ces of Assembly- ANNUAL <br /> © Fire Protection Maintenance - ANNUAL = Recreational Burn <br /> UM prim Other <br /> Sprinkler El ❑ ❑ ❑ 12 Sparklers <br /> Fire Alarm ® ❑ ❑ ?4,1 I n Sprinkler System Installations <br /> Hood Cleaning El ❑ ❑ ❑ I I El Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I J Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation a Waste Tire Storage ANNUAL <br /> R Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 1 Valuation of Project <br /> E Fuel Tanks <br /> Other: I I <br /> .. <br /> Contractor Company A T -- I s t Won , wG I <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address 3531 Ifs e9 ne. Rat. I License# I EF0000hN1 I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N J Fee Current I Y / N I <br /> Address ( ____I License # ( I <br /> PLUM8ER ' Company I <br /> Signature , Registered Y / N 1 Fee Current I Y / N I <br /> Address I I License # ( I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER <br /> -1 1 Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I 1 License # I I <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 52500, a Notice of Commencement is required (Mechanical work over 55000) <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 />