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4 `c <br /> .3'r ii( <br /> 813-780:0020 City of.Zephyrhills Fire ( Fax-813-780-0021 <br /> Permit Application <br /> Date Received 4O1c 01 .27 11 Phone Contact for Permit r / m 673 S L <br /> Owner's Name L 6■ZZ-O 71160017/11 Owner's Phone Number gg / 3 3415 q' 3 s( <br /> Owner's Address P0. FaBOX q738 / T + j FL 33674 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Address <br /> Job Address b OLD& A/ P,gJDA 37 ?/. E A 13 D` Lot # <br /> Sub Division <br /> Parcel <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 /> n 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 /> I I <br /> n Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL <br /> IQtrlyl ISemil J Other <br /> Sprinkler D ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning r ❑ ❑ I I ' I Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ 1 1 [] Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> El Fire Pumps n Waste Tire Storage ANNUAL <br /> El Fire Works <br /> n Flammable Application- ANNUAL Valuation of Project <br /> I - 1 Fuel Tanks <br /> n Other: I I <br /> ,v.. :a2pas r5... ? rol. _... K , ..:' v-�<< -a - sC. „m .,c, "e+ <', F . aik - ba..,at ✓. Fm k -n .HY,r , . -�� -_. L- �:i:K. skbF't.,'��..:.::M^..,s'& . >4 W?"".. ",�'Sda. �b.Y :' <br /> Contractor Company (��// j $ S i t VK/Fs <br /> Signature •0•11—t--4 Registered Y/ N I Fee Current I Y / N <br /> Address I License # <br /> ELECTRICIAN Company I <br /> Signature I Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered . Y / N I Fee Current I Y / N <br /> Address I I License # <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address License # <br /> ._. >,.: <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 />