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�)� � Fax-813-780-0021 <br /> ei3-78o-0o2✓/y�- City of.Zephyrhills Fire• <br /> L �t'1 C - Permit Application <br /> ✓' �� <br /> �ate Received � ��� �� �� ' Phone Contact'for Pertnit J-'-- r-=��� ��/ I <br /> :�a•.s�%�-:>;�.�� ...,......, � - - aas.:.:�;. z �,:� =-�"'=a�.�i.�-,dr .s. ...a,_�.�s-...�.._.-..._L__ <br /> � � . � - � z� 3 S � 3S <br /> )wners Name Owners Phone Number <br /> )wners Address , lJ �o � � ��� �� �� � " <br /> ee Simple Titleholder Name Titleholder Phone Number � C� � <br /> ee Simple Titleholder Address _ __ <br /> .;' v-. m,�^�',,,z.•'[$��.:��s�����i ��'-'``�'"�.�4-��'"�- n a�m'�fl n,T'�. ����r�=.."E:=v���. <br /> �%��=r�-,.�"�''s�'_i��'� "'. z�''� <br /> l� �;(/ a�t/ p G�1 �L �, �o� � 0 <br /> ob Address - <br /> Parcel # <br /> �ub Division - _ <br /> � Bio-Hazard Waste Storege - ANNUAL a Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Faciliiy) ANNUAL <br /> a Controlled Bum � Hood Instatlation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Gene2tor > 30 kw a LP/Natural Gas-ANNUAL Sale <br /> a Fire Protection Maintenance - ANPtUAL � Places of Assembly-ANNUAL _ <br /> ❑ r y aemi X�nT� er °•y <br /> �-J/ / / <br /> Sprinkler ❑ � � � � Recreational Bum / <br /> Fire Alartn � � � � � � Sparklers /7 �/y <br /> / r � ,� 1 <br /> Hood Cleaning �❑ EY � � � Sprinkler System InstallaGons I I <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes (Sprinkler Sys) \ <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storage ANNUAL <br /> a Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fue( Tanks <br /> a Other: <br /> ��e�����u �.a�r �.K.�.,�.. ��r-� ��� �x*_ ��. <br /> �ontractor Company � ` <br /> Signature Registered l� � Fee Current Y 1 N <br /> Address License # �— � <br /> ELECTRICIAN Company <br /> Signature Registered Y/ I�l Fee Curre�t Y/ N <br /> Address License i� �— � <br /> PLUMBER Company <br /> Signature Registered Y/ Iv Fee Current Y/ N <br /> Address �— _ License !� <br /> MECHANICAL Company <br /> Signature Registered Y/ f�l Fee CuRent Y/ N <br /> Address License # <br /> OTHER Company <br /> Signature Registered �' /(�l Fee Current Y/ N <br /> Address License # <br /> Directions: <br /> FII out application completely. <br /> Owner 8 Contractor sign back of application, notarized (�r, copy of signed contract with owner) <br /> if over 52500, a Notice of Commencement is �equired (Mechanical work over $5000) <br /> Supply iwo (2) sets of drawings with applicable documentation <br /> Allow 1Q14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />