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813 - 780 - 0020 City of Zephyrhills Fire ( \ 5 J 7 Fax - 813 - 780 - 0021 , tr - <br /> Permit Application <br /> Date Received <br /> Altor+e.Qontact for Permit i <br /> Owner's Name ID <br /> l ' ` <br /> -- _��� _ ii \ ro Li-. r • er's Phone Numb- 1 6 / 3 17 r0. 115120 c 1 <br /> Owner's Address J () (o i)p� �� h to kdo, (1 y Y t 1, t <br /> Fee Simple Titleholde m e I Titleholder Pl_ma.Ntrnirer I I I <br /> Fee Simple Titleholder Address--1 — - --° <br /> Job Address 3- 84 5- (;-4 G' B l ✓,,( <br /> Sub Division /V r ( 1 I v h \ P. L 4 Parcel # Lot # <br /> El Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct El Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Burn n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> W n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> W Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL <br /> Qtrly 'Semi I GL j Other <br /> Sprinkler 1 X ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ ❑ I 1 n Sparklers <br /> Hood Cleaning 0 ❑ ❑ ❑ I J n sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I i n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> D Fire Pumps n Waste Tire Storage ANNUAL <br /> 0 Fire Works <br /> F Flammable Application- ANNUAL I i 35 c.),-c.),--) �� 1 Valuation of Project <br /> � — , I ' Fuel Tanks <br /> n Other: <br /> � I <br /> Contractor ` ] 4 . <br /> Company,. I�.�(4 a � i lam, I I <br /> Signature Registered / N ,(I Fee Current Y / N <br /> Address QC t <br /> L + s I, ; License # ( S i' ?..cJ(-pc> „,? I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I J <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address J I License # I 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 />