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-813- 780 -0020 City of Zephyrhills Fire 4 l ( Z, ( (,f ,, Fax -813- 780 -0021 <br /> Permit Application ( �J &/Ll f2 <br /> Date Received 1 / ats8 //v 1 Phone Contact for Permit 1 ,� 2 11 •/ 1 1 a /op <br /> Owner's Name 1 I? - p,. - -14 (' .,a 1 Owner's Phone Number 1 7Z7 1 I' 5Z 1 1`/534 I <br /> Owner's Address lia 1 & p ntaAg' - <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> I , <br /> Fee Simple Titleholder Address <br /> Job Address 113 20 ‘24tA, &vd Z-ePA 4 el this Lot # <br /> Sub Division I Parcel # I I <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum a Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> rY I i L•i fl <br /> Sprinkler 0 ❑ ❑ ❑ n Recreational Bum /Y L/� <br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers =-�'� <br /> Hood Cleaning 1=1 ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I 1 17 Standpipes (Sprinkler Sys) <br /> - ✓ Fire Alarm Installation ) n Torch Roofing/Tar Kettle <br /> _ Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> r Flammable Application- ANNUAL 1 go. . c, CZ', , r I Valuation of Project <br /> �ri Fuel Tanks <br /> Q Other: <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current I Y/ N j <br /> Address 1 I License # <br /> ELECTRICIAN Company <br /> Signature 1 Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N J Fee Current 1 Y/ N 1 <br /> Address I I License # <br /> OTHER Com an <br /> " -_ I�DOG 3� P Y �.. ' tierce . lCIVS <br /> Signature R egistered i M Fee Current Y / N ' " <br /> Address /34 4 ,, _ ✓ License # p coot, 5 /t7 I <br /> Directions: — 7 - G--- Pe # q� 331,/r <br /> Fill out application complet ly. <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 />