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813- 780 -002n" City of.Zephyrhills 'Fire 11 0161 Fax - 813- 780 -0021 <br /> Permit Application <br /> Date Received 1 Phone Contact for Permit „AL,._ 44s 1 s7 <br /> Owner's Name 1. 7.1 .cat 0 'tk )R r/e9 f /1 Owner's Phone Number S S *' y 3g1 <br /> Owner's Address <br /> =ee Simple Titleholder Name Titleholder Phone Number <br /> =ee Simple Titleholder Address <br /> - V . yx, n:^7,'.--,,-, .h:,.,,� .eK . ,=1 4 <s sr.;.. . y: _ _ . rag" w °L <br /> ice; ?'. ��.vw;� »� �:,w7 �t� rk h . �� �tasr. -se: � _ J� /� . <br /> Job Address (H / /v/ / WVJK 72,5? &eq� 7LL',0 Lot# <br /> Sub Division Parcel <br /> I Bio-Hazard Waste Storage - ANNUAL ( Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> Emergency Generator < 30 kw LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw ( LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> !LIMY' I semi1 IAN I Other <br /> Sprinkler I ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning 2' ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression , ❑ ❑ ❑ I I ( I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation Y I Torch Roofing/Tar Kettle <br /> Fire Pumps n. Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I •I Valuation of Project <br /> Fuel Tanks <br /> I Other <br /> Contractor / Company W1,VI tg EtaM <br /> Signature ' Registered Y / N Fee Current Y / N <br /> Address 1 I License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/11 I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N 1 <br /> Address I I License # ( I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address License # <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 (httpJ /appraiser.pascogov.com) <br />