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813-780 -0020 City of Zephyrhills Fire Permit Application Fax-813-780-0021 Date Received I I I I I 1 1 I / Phone Contact for Permit 1 Owner's Name I /St.; T hJi7e� iG( * / iS T i- rirG4 I Owner's Phone Number I g"Y 3 J 1 7PA I I j-4 yJ�I Owner's Address I S�3S^ , -r1+ 4" - y . L// ,.Z • I Fee Simple Titleholder Name I I I I I I I Titleholder Phone Number I Fee Simple Titleholder Address I Job Address 1 I I I I Lot # Sub Division I I Parcel # El Bio- Hazard Waste Storage - ANNUAL n El Fumigation Tent Comm Exhaust Kitchen Hood /Duct 0 Hazardous Material 0 (Tier II or RQ Facility) ANNUAL Controlled Bum Hood Installation El Emergency Generator < 30 kw ni LP /Natural Gas - Installation Emergency Generator> 30 kw = LP /Natural Gas - ANNUAL Sale Fire Protection Maintenance - ANNUAL I I� T1 Semi ' Places of Assembly- ANNUAL r El i �-•� �r I 'Semi' C !Other I Sprinkler ❑ ❑ ❑ Recreational Bum Fire Alarm 0 ❑ ❑ ❑ I 1 El Sparklers Hood Cleaning 0 ❑ ❑ ❑ I ( I (�'� ® I Sprinkler System Installations Hood Suppression ❑ A ❑ I I n Standpipes (Sprinkler Sys) n Fire Alarm Installation n Torch Roofing/Tar Kettle n Fire Pumps n Waste Tire Storage ANNUAL n Fire Works n Flammable Application- ANNUAL I I n Valuation of Project F uel Tanks Q Other: I Contractor Signature I Company I Registered I Y/ N J Fee Current I Y N Address I I License # I I ELECTRICIAN I Signature I Company Registered Y / N J Fee Current I Y/ N J Address I 1 I PLUMBER License # I Signature ! Company I I Registered I Y/ N J Fee Current I Y/ N I Address I I I License # I MECHANICAL! Signature I Company I Registered I Y/ N J Fee Current I Y/ N I Address I 1 License # I I )THER signature I Company El, - S4 Address I I Registered ira Fee Current latill Arections: License # I e 4//794. I Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice h //a ( ttp: ppreiser.pascogov.com)