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813- 780 -0020 k l (✓" City of Zephyrhills Fire Fax- 813- 780 -0021 Permit Application Date Received I 1 Phone Contact for Permit I} z-+ 1111-11 I I I Owner's Name IMIVESIBEIMM . G / Owner's Phone Number 1 3 I 775-11 /59q1 Owner's Address I D i 3- i ), 0 1_/ 6v / y P.i . Ztof {1 ( AIM A7, 3s I Fee Simple Titleholder Name Titleholder Phone Number I 1 1 11 I Fee Simple Titleholder Address Job Address I Lot # I Sub Division I I Parcel # I I I Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL ED Comm Exhaust Kitchen Hood /Duct El Hood Installation El Controlled Burn Q LP /Natural Gas - Installation LI Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale n Emergency Generator> 30 kw n Places ofAssembly- ANNUAL I x I Fire Protection Maintenance - ANNUAL Recreational Burn IQtrlyI I Semi I MI'Other 1 Sprinkler 15 (1 ❑ ❑ I Sparklers Fire Alarm [] ❑ ❑ ❑ I I I I Sprinkler System Installations Hood Cleaning ❑ ❑ ❑ I n Standpipes (Sprinkler Sys) Hood Suppression 0 ❑ ❑ 0 I 1 1 I Tor ch Roofing/Tar Kettle Fire Alarm Installation n Waste Tire Storage ANNUAL El Fire Pumps n Fire Works n Flammable Application- ANNUAL I Valuation of Project Fuel Tanks n Other: I Contractor -r•- _. ,,::: _ _: _ -. g I Com I A To la I So Iu4i o I Signature 1} Registered Y / N Fee Current Y / N Address 3531 I', ,.}.one, I I License# ( Qg35 3S000lA0oA, ELECTRICIAN I Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I 1 License # I PLUMBER I Signature Company I I Registered 1 Y/ N I Fee Current I Y/ N I Address I I I License # I MECHANICAL' I S Company 1 Signature Registered Y/ N j Fee Current I Y/ N I Address 1 License # I OTHER I I Company I Signature I Registered Y/ N ] Fee Current I Y/ N I Address I I I License # Directions: 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 (http: / /appraiser.pascogov.com)