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813- 780 -0020 City of.ZephyrhillsFire. f 117 0 Fax - 813 - 780 -0021 <br /> Permit Application , 3 . <br /> ` <br /> Date Received I /1 2 1 10 - Phone Contact for Permit �; 1 .5 19 3 ."7 <br /> �� � <br /> • <br /> Owner's Name 4 / -OR.(/7J hL Owner's Phone Number I g ( Z I 5-2 • I 1 35 <br /> Dwner's Address 7 • V, 5o/1 /7-W -W ��" /M , -. . 3 36. 7 ' <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> ee Simple Titleholder Address M 4 <br /> A .. <br /> :`Mk'Xi�'.X' '. b`i�xPF:iFX•. "a'(wL4�'.�- . -..`K� «K: %tea. - . Yr �{—�- {� /►�eT �–y� <br /> Job Address � �l_ � AURT) v 1 .t/ /7 G,qill_ VD Lot# <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I I Controlled Bum I Hood Installation <br /> I I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I Places of Assembly - ANNUAL <br /> ILttriyj (Semi I lAnl I tither <br /> Sprinkler I 1 ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm I 1 ❑ ❑ ❑ I .1 I I Sparklers <br /> Hood Cleaning I LA ❑ i ❑ I I I Sprinkler System Installations <br /> Hood Suppression I 1 ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation I ', Torch Roofing/Tar Kettle <br /> I I Fire Pumps I I.. Waste Tire Storage ANNUAL <br /> Fire Works <br /> I I Flammable Application - ANNUAL I ) Valuation of Project <br /> I Fuel Tanks <br /> I I Other I _. <br /> /s <br /> Contractor Company (� At I V S 1 C • <br /> Signature Registered Y / N I Fee Current Y / N I <br /> Address 1 I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I I License # ( I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current L Y/ N I <br /> Address License # 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 $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 / /appraiser.pascogov.com) <br />