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813 -780 -0020 City of Zephyrhills Fire ft (( 4 Fax- 813- 780 -0021 <br /> Permit Application <br /> Date Received I 1 Phone Contact for Permit I 11 11 <br /> J <br /> Owner's Name ( ///e /d(a /2 V/ C L'' 0,--, ' <br /> - Owner's Phone Number /(� 11 17/). x0 <br /> �. <br /> 3 <br /> Owner's Address 7 c - 7 - 1 66 ) RL1/1 /a S * jZ-)C-' r( J'alii(e <br /> Fee Simple Titleholder Name Titleholder Phone Number 1 1 <br /> Fee Simple Titleholder Address _ <br /> I <br /> / ) a/ � //� Fi.3 1J� - 9s5 , Lot# <br /> Job Address Y / 111 l (U[= `S -�`�/ / (`fib i �u+ <br /> Sub Division Parcel # I <br /> I 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 /> F - 7 Controlled Burn n Hood Installation <br /> I — I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Fill n Places of Assembly - ANNUAL <br /> r y !Semi !SeOther <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression ILI ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> El Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> n Fuel Tanks <br /> ni Other: I I <br /> Contractor Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address ( I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address 1 I License # ( I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I 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. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />