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813 - 780 - 0020 City of Zephyrhills Fire <br /> Permit Application Fax-813- 780 -0021 <br /> Date Received I at •- 2-1s - 1 ‘ <br /> Phone Contact for Permit I I <br /> Owner's Name v (C.) I}t- t� j 5 0 I <br /> Owner's Phone Number <br /> Owner's Address j'2e '1 6cc u- 8/....0 n °Z-cp h v r-141 L-4, FL . 3 3 Sw z -Z 5" 70 <br /> Fee Simple Titleholder Name I I I <br /> Titleholder Phone Number = <br /> Fee Simple Titleholder Address I <br /> Job Address <br /> q <br /> � Z C � (. c 1 <br /> y 0Wp Ze ,P ktitI L..5 ff(., 335 a ---e- 5 I <br /> Sub Division <br /> I 1 Lot # <br /> Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL <br /> El <br /> Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility} ANNUAL <br /> n Controlled Bum <br /> El Hood Installation <br /> Emergency Generator < 30 kw <br /> LP /Natural Gas- Installatiory ' p <br /> Emergency Generator > 30 kw LP /Natural Gas- ANNU/,C Sale . - <br /> Fire Protection Maintenance - ANNUAL L� ( " <br /> I Places of Assembly - ANNUAL <br /> ❑ �, - • „�t �� MA (Other I <br /> Sprinkler 0 0 <br /> Recreational Bum <br /> n o o . I 1 <br /> Fire Alarm <br /> I ._� i Sparklers Jt'' <br /> Hood Cleaning p 0 <br /> I I Sprinkler System Installations <br /> Hood Suppression n O ID ID I I El n Standpipes (Sprinkler Sys) <br /> F Alarm Installation <br /> I� I Torch Roofing/Tar Kettle <br /> I Fire Pumps <br /> I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> El Flammable Application- ANNUAL I 1 <br /> n Fuel Tanks Valuation of Project <br /> Q Other: I <br /> Contractor g. <br /> Signature Company , �L• feQ�S <br /> �`— Registered Y / N Fee Current Y / N <br /> Address I I <br /> License # <br /> ELECTRICIAN I <br /> Signature I Company <br /> Registered Y / N Fee Current Y / N <br /> Address I I <br /> PLUMBER License # I <br /> Signature I I Company I <br /> Registered Y/ N I Fee Current I Y/ N J <br /> Address I <br /> MECHANICAL( I License # I <br /> Signature I I Company <br /> Registered Y / N Fee Current Y / N <br /> Address I I License # I <br /> OTHER I <br /> Signature I Company <br /> Registered Y/ N J Fee Current I Y/ N <br /> Address I <br /> I License # <br /> Directions: � 3 . <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 />