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813aiwa -0020 City of.Zephyrhills Fire Fax -813 -780 -0021 <br /> *Permit Application <br /> Date Received <br /> ����,�._ �»:�•�,�....,,..�:��- , ..tea; _p .,�.�. " � -�� _ .�_�.. ..A.. ,...� -, . .,� ,� ...- ..» -..�,� �.- „....�.�.._.,___ <br /> Phone Contact for Permit 1 1 I ) <br /> Owner's Name 17 AV idi 444j 2- de. 4 f ate eft[ Owner's Phone Number ei3 7P2 l O7/y <br /> Owner's Address 39.2+'? .a AS'E Z M f4- <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitleholder Address I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> F...- <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> J Qtrly� Semi I ' Other <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n no ❑ ❑ I I n Sparklers <br /> Hood Cleaning © ❑ ❑ X I I n Sprinkler System Installations <br /> Hood Suppression ® ❑ Jitl ❑ I 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> FT Fire Works <br /> Ej Flammable Application- ANNUAL I Valuation of Project <br /> FT Fuel Tanks <br /> I—I Other: I <br /> Contractor Company <br /> Signature Registered Y / N 1 Fee Current I Y / N j <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N . 1 Fee Current I Y/ N I <br /> Address I I License #. <br /> PLUMBER Company <br /> Signature Registered Y / N ] Fee Current I Y / N J <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N j Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER Company - ,,- vr11 _ F 4 vi - •....'7 4C <br /> Signature / Registered rM111 Fee Current r ran i <br /> Address I License # <br /> G SYDOV ig9 , <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 />