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• <br /> ' g- 813- 7dB -0o2U City of ZephyrhillsFire.- Fax -813 -780 -0021 <br /> Permit Application <br /> late Received • - Phone Contact for Permit I II <br /> ;ter J -- « , <br /> )wner's Name II . , LK__ (N r 1.) t — Y1 : Owner's Phone Number I 11 11 <br /> )wner's Address ` (‘ A � > 3 � c.■ \ ` ` J . , .e, �,• , `1 S .J `� i / 7 <br /> :ee Simple Titleholder Name 1 .1 Titleholder i1 older Phone Number ( 1 I <br /> :es Simple Titleholder Address <br /> Job Address I C M CA Lot # <br /> Sub Division 0_, + . , p 2,e . . I Parcel # 1(. 3 ) - ---,./ 00,k -- ccCxjo -061 L <br /> n Bio-Hazard Waste Storage - ANNUAL ED Fumigation Tent <br /> ED Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RO Facility) ANNUAL <br /> LJ Controlled Burn rI Hood Installation <br /> E l Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> • <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> I )Semi) ®'tuner <br /> Sprinkler ❑ ❑ ❑ I� Recreational Bum <br /> Fire Alarm ❑ ❑1 I I ED Sparklers <br /> Hood Cleaning ❑ ❑ / I I Sprinkler System Installations <br /> Hood Suppression jJ ❑ ❑ ❑ I . I El Standpipes (Sprinkler Sys) <br /> ED Fire Alarm Installation = Torch .Roofing/Tar Kettle <br /> Fire Pumps a Waste Tire Storage ANNUAL <br /> Fire Works • <br /> Flammable Application- ANNUAL 1 1 Valuation of Project <br /> Fuel Tanks <br /> Q Other. 1 <br /> Contractor \ _ 1111 Company IA ; • •., ,, - - .G %tit __f C• <br /> Signature J \ • Registered IRVALIII Fee Current fS N <br /> Address 3 . • - . - 1,-, r _ License # I S F (DE) 10 H l I <br /> ELECTRICIAN - Company <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address 1 ` License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N F ee Current Y 1 N <br /> Address I 1 License* I <br /> MECHANICAL Company <br /> Signature Registered Y / N ] Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address I Lice # <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 (http:1 /appraiser.pascogov.com) <br /> . . <br />