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813-780 -0920 City of Zephyrhills Fire 4171( / �J 7 Fax -813 -780 -0021 . <br /> Permit Application <br /> Date Received Phone Contact for Permit 1 7L'7 I z/ I _) 640 11 <br /> Owner's Name I Z fart Owner's Pho ne Number 411 vrtN, «s /.c. Lc z73 i � S 13 1 7 Sz ( 4Gof <br /> Owners Address 66 C/ 144 44 4 O4 / L 'too f re h/ «b 1%. 335 39 <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address G & ci G.I . 44 ke 4 n , Z I Q Y ell / 5 a J 3 3 S 39 Lot # <br /> Sub Division Parcel # <br /> ED Bio-Hazard Waste Storage - ANNUAL E=I Fumigation Tent <br /> Q Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> © Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> �Si/ 'Semi IAN j Uther <br /> Sprinkler © ❑ ❑ x I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression E1 ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> 7 Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> R I I Fire Works <br /> Flammable Application- ANNUAL ,. L 2 S, e_ f Valuation of Project <br /> Fuel Tanks <br /> 7 Other: I I <br /> Contractor �/� Company t/ S 4 1.+ s p R f„ rio .../ S:c e v.ci s L L G. I <br /> Signature / Q�.-.� . ��l'.,_►✓� P w Registered Y / N I Fee Current I Y / N <br /> Addres ZO& 7? op.c d Lv4 Eia%T Lw .rgo , A. 33770 I License# I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N _I Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N _I Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current L Y/ N I <br /> Address I 1 License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I I License # I I <br /> Directions: , <br /> • <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) * i <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 (httpj /appraiser.pascogov.com) <br /> t <br /> r <br /> r <br />