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813- 780 -0020 4 1 73 <br /> W <br /> City of Zephyrhills Fire �� Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received } Phone Contact for Permit 13,S ? 166k I ffi <br /> Owner's Name J 4-41 I l ■S r 0 ck 4 (L_ Owner's Phone Number 1 ,?..""15. '112 I <br /> / ( iiv I <br /> Owner's Address yj S ry 1 d ' <br /> Fee Simple Titleholder Name •.. /4-- Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I /-) 1 /i" <br /> Job Address S — Y. i. c // J /U <br /> / v Lot # <br /> Sub Division ei 'TX C l 2q4/ , <br /> " �.5 � Parcel # ( // -x( -? r 00i o - 070 0 — Oa/ 0 I <br /> � (OBTAINED FROM PROPER rY TAX NOT ICE) <br /> I I Bio- Hazard Waste Storage - ANNUAL I 1 Fumigation Tent <br /> I I Comin Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Burn I I Hood Installation <br /> I J Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> II <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly - ANNUAL <br /> Sprinkler I Recreational Burn <br /> Fire Alarm �I / Sparklers <br /> Hood Clean /Suppression '`� Sprinkler System Installations <br /> I Fire Alarm Installation 1 I Standpipes (Sprinkler Sys) <br /> I Fire Pumps I I Torch Roofing <br /> I Fire Works I I Waste Tire Storage ANNUAL <br /> Flammable Application- ANNUAL <br /> Fuel Tanks I I Valuation of Project <br /> I Other: <br /> Contractor L _ Company G j! (/ S /1 / air -t C.- <br /> Signature Registered ram Fee Current <br /> Address 3/ ( Cr S i r ;i7y WPM �� \Gei � � �/ /����� License# I FC,tyc� ��CiQ <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I <br /> License # <br /> PLUMBER Company J <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address I <br /> License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address I I License # 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_ <br />