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813 -780 -0020 City of Zephyrhills Fire <br /> Fax - 813- 780 -0021 <br /> Permit Application <br /> Date Received I t 2 ( iS l/ p I <br /> Phone Contact for Permit 1 6/3 1 l?& 1 l 4 f /6 9 I <br /> Owner's Name I F✓ a- <br /> f 7' Z 7 1 Owner's Phone Number I ff i I I 4-77 1 IS- 3 Cg I <br /> Owner's Address 1 rj l / q 6 //' /3/!/!l 2 / ,(.l /% ?/ S �`/ 3? <br /> Fee Simple Titleholder Name I ! I I I I I I <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address I , / cr 11 " /d <br /> i I Lot # I <br /> Sub Division I Parcel # I <br /> 17 Bio- Hazard Waste Storage - ANNUAL ri Fumigation Tent <br /> n <br /> ED Comm Exhaust Kitchen Hood /Duct a Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> Controlled Bum I Hood Installation <br /> n Emergency Generator < 30 kw = LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw [] LP /Natural Gas - ANNUAL Sale <br /> (2:1 Fire Protection Maintenance - ANNUAL n Places of Assembly -ANNUA �1 <br /> ❑ IQtrlyl'Semi) Will 'Other I /I rt9- <br /> 6 <br /> Sprinkler ❑ ❑ ❑ n / <br /> Recreational Burn u /I/ <br /> Fire Alarm n ❑ ❑ ❑ I I J Sparklers <br /> Hood Cleaning El ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression z 1Z1 ❑ 24 ❑ I I n Standpipes (Sprinkler Sys) <br /> 17 Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> Fire Pumps = Waste Tire Storage ANNUAL <br /> ED Fire Works <br /> n Flammable Application- ANNUAL I 'Z 0 0 I <br /> E Fuel Tanks Valuation of Project <br /> 0 Other: I <br /> Contractor <br /> Signature' rl /.T/— .. Company In InL <br /> Registered I Y/ N � Fee Current I Y/ N I <br /> Address Er 0s i ♦,_ ► i , ,, . 0 - a.,. 3 .... I <br /> � Licens # I <br /> ELECTRICIAN <br /> Signature I I Company <br /> Registered I Y/ N 1 Fee Current I Y/ N J <br /> Address I <br /> 1 I <br /> License # <br /> PLUMBER <br /> Signature I Company I <br /> Registered Y/ N 1 Fee Current I Y/ N 1 <br /> Address I I I <br /> License # I <br /> .1ECHANICALI I <br /> >ignature Company I <br /> Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I ( I <br /> License # I <br /> )THER <br /> lignature I Company <br /> Registered I Y / N j Fee Current I Y/ N I <br /> Address <br /> iirections: <br /> License # I <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 h //a <br /> ( ttP� PPreiser.pascogov.com) <br />