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813-780-0020 City of Zephyrhills Fire I ' 1 0 ( ( Fax- 813-7$0 -0021 <br /> Permit Application <br /> Date Received l a- /h 1 Phone Con - r__ •3 <br /> — <br /> Owner's Name jl In i , # A - 1 6 Owner's Phone Number I 1 1 1 1 I <br /> /Owner's Address 7, N r: _4": l ../! • i - 3 II s '_ i - • ?. A ' <br /> Fee • le eholder Name Titleholder Phone Number I I I <br /> Fee ' ple Titleho r Address I <br /> Job Address -74 �� C� S 2 h/ `� �� Lot # <br /> Sub Division I Parcel # I I <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum = Hood Installation <br /> Emergency Generator < 30 kw I ( LP /Natural Gas- Installatior 6/? ,9r7 / (1° DI6 7/ 5) <br /> r . Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ry (Semi (j Other /� , // <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum _ /� /�!/ /(cam <br /> Fire Alarm 0 ❑ ❑ ❑ I I n Sparklers 1/' <br /> Hood Cleaning 0 ❑ ❑ ❑ I 1 n Sprinkler ys em Installations 4 <br /> Hood Suppression 0 ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL 1 I Valuation of Project <br /> n Fuel Tanks <br /> Q Other: I <br /> Contractor Company <br /> Signature Registered Y/ N � Fee Current I Y/ N <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature I Registered Y/ N I Fee Current 1 Y/ N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N J <br /> Address I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # I <br /> OTHER ' ��� �' <br /> / � . C ompany ►ii:i.t' ' LJ : l <br /> Signature / • / 41 I Registered Y / N Fee Current Y / N <br /> Addres aLzenfin p A S�� License # I D7 3 s- <br /> 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 />