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91 7BO -0C2O City of Zephyrnllls Fire ran - o I o l ov - wL I •
<br /> Permit Application
<br /> Date Received Phone Contact for Permit 5 8 '13 GL I 1 13x
<br /> Owner's Name , c(,012.00.-- ffZ c_C,) rt, u- Owner's Phone Number ,
<br /> Owner's Address 36)3. mfkg4.J T INJA Zc1300-i)ILLS , p(, . 39s4o
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee SimpleTitleholderAddress
<br /> c - -., .7.0,a c ..- .'s;+:_ _.�,., •, .s"."" - .NnUfZ2StZMI: s- ZVJZ ZSE::. -x 4.A." .' m."-x „z m5 5.'Fr, Yr. ra ti. _.
<br /> Job Address 56 OS) P'sree -r.ldT :.t OMM-z Lot #
<br /> Sub Division Y'r ri (71P Z anti L•thea.. . ( Parcel # Z.1 • DO • () 35�
<br /> D7 �' Z( .• IU v
<br /> Cti ., *-- ,- A.,- +� »----,W •-.., .: - 'ti_ -4 rtNa.,, „,., -,,,, , • .... ',..3i .',._ aggitanftWASIMECIMMINZWAIMITAMILVMZWISMAZIttae
<br /> I Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I Controlled Bum I I Hood Installation
<br /> 7 Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> I Emergency Generator> 30 kw h LP /Natural Gas - ANNUAL Sale /' ZO 41:f I Fire Protection Maintenance - ANNUAL I I Places of Assembly - ANNUAL .
<br /> lutriyl ISemi' tither
<br /> Sprinkler 71 0 ❑ ❑ ( Recreational Burn
<br /> Fire Alarm ! 1 ❑ ❑ ❑ 1 I 1 Sparklers OD
<br /> Hood Z,
<br /> Hood Cleaning I ❑ ❑ ❑ I I Sprinkler System Installations I v
<br /> Hood Suppression I ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys)
<br /> I Fire Alarm Installation I I Torch Roofing/Tar Kettle
<br /> I Fire Pumps I I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I -4 Z-C.,4,>C0 I Valuation of Project
<br /> I Fuel Tanks
<br /> I Other:
<br /> $�'. !- i,.ew: i£�Ipz< - sY- ^r „�,p. �S.wuY.'..:. �N .ze,^ }i : �.c.�s...'� s��k'd..cR6. _°a`_�xr .s. , a.i,: i >_.., ....- .» 'aa _M'6+`"t`: cr �?51;'F�s F.a�� � ...�•• SirY,.::� v+�C >.':'”` k , Yv r.-,�;Mw r�y k?fi.:�ca. /iJ.'m4�S;Y:_,,,,x
<br /> Contractor i712- Company (�7"P r- P11US z.rnX.C.,C- - h5 r M., ,
<br /> Signature 41 ` Registered c N I Fee Current a/ N
<br /> Address I License# I t.(o 8 4S Toc.27f I Ss I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N Fee Current I Y / N J
<br /> • Address I I License # I I
<br /> PLUMBER Company
<br /> Signature Registered Y / N 1 Fee Current I Y/ N J
<br /> Address I • 1 License # I I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I I License # I I
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y / N
<br /> Address 1 License #,,,, •
<br /> taw ..._ ..,.__ .a....,.,... �*,� � .,1
<br /> Directions:
<br /> Fit 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 $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: /J'appraiser.pascogov.com)
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