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F ' <br /> 813 -780 -0020 City of Zephyrhills'Fire.. Fax - 813 -780 -0021 <br /> Permit Application <br /> .4 Ill AM <br /> late Received r,AY — <br /> Phone Contact for Permit l 1 <br /> • <br /> hvners Name e 5 r n P `Gl yt e' 13 T� to ‘+ Owner's Phone Number `Xi 3 , ��/ _� .4c <br /> owners Address , 5 1 n •u Y' 1 n t_ ‘ e,, • , I • <br /> =ee Simple Titleholder Name ( Titleholder Phone Number I 1 ( I <br /> :ea Simple 'Titleholder Address I . <br /> Job Address • . . _. r . 1 Lot # I <br /> Sub Division Parcel # I , — - • 'a. - apt A - .A-0 / v <br /> n BIo-Hazard Waste Storage - ANNUAL El Fumigation Tent <br /> E Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANN <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw h LP /Natural Gas - Installation l (/ <br /> Emergency Generetor> 30 kw n LP/Natural Gas - ANNUAL Sale <br /> • <br /> Fire Protection Maintenance - ANNUAL I { Places of Assembly- ANNUAL >> <br /> j �ieml) 6,0 Uarer <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ / I I E Sparklers <br /> Hood Cleaning LJ ID ❑ ❑ ❑ I I n Sprinkler System installations <br /> Hood Suppression [J ❑ ❑ 0 I . I n Standpipes (Sprinkler Sys) <br /> Q Fire Alarm Installation 1=3 Torch.Roofing/Tar Kettle <br /> R Fire Pumps = Waste Tire Storage ANNUAL <br /> Fire Works • <br /> ® <br /> - Flammable Application- ANNUAL I 1 Valuation of Project <br /> Fuel Tanks <br /> I-I Other: I <br /> Contractor _ Company FN. 1 _.G -�, Mit __ <br /> �p • <br /> Signature )U l k � Registered �1d� Fee Current �9' - � <br /> Address 3 1 . - r s License # I E F. )t ) b 1 O ii k` I <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y / N Fee Current Y 1 N <br /> Address 1 License # <br /> PLUMBER <br /> Company <br /> Signature Registered Y / N J Fee Current 1 Y / N I <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y / N 1 <br /> Address I I License # I <br /> OTHER Company <br /> Signature <br /> Registered Y / N Fee Curre Y <br /> nt / N <br /> Address License # <br /> Directions: - ,�- <br /> Ril out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> • <br /> If over 52500, a Notice of Commencement is required (Mechanical work over 55000) <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.pascagov.com) <br /> . . <br />