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s�saso-oo2o City of Zephyrhills Fire <br /> ° Permit Application Fax-813-780-0021 <br /> Date Received 0 � � <br /> Phone Contact for Permit g t3 �'�6 /�� s � <br /> �. �-�.� <br /> Owner's Name l rl /�f�-/� $r <br /> '�n� Owner's Phone Number �83 ZZ7 <br /> Owner's Address �� 3� �s"/'��.� ��"� ,/� z i 33 3ry Z <br /> Fee Simple Titleholder Name � �� � <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> _ ,. ,, �_ . <br /> Job Address ('j 3. �r�� � f- <br /> , %l .33�� Z .: �o� # �� <br /> Sub Division <br /> , . . , Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � � � <br /> a Fumigation Tent <br /> Comm Euhaust Kitchen Hood/Duct <br /> � � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum Hood Installation <br /> � Emergency Generator < 30 kw � <br /> � LP/Natural Gas-Installation <br /> Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � <br /> Places of Assembly-ANNUA <br /> ❑ CLI r�y emi nT er � <br /> Sprinkler ❑ ❑ ❑ � Recreational Bum f�� Q` <br /> Fire Alartn � � � � �� ❑ <br /> Sparklers <br /> Hood Cleaning �❑ ❑ ❑� � Sprinkier System Installation <br /> Hood Suppression � p �j � r � — <br /> � / , v �_._� Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation � Toroh Roofing/Tar Kettle <br /> � Fire Pumps a Waste Tire Storege ANNUAL <br /> � Fire Works <br /> Flammable Application- ANNUAL <br /> � Fuel Tanks Valuation of Project <br /> Q Other: <br /> Contractor � . , <br /> Signature Company � • �� � � ^ � <br /> Registered Y/ N ee Current Y/ N <br /> Address o p � � <br /> � License # <br /> ELECTRICIAN <br /> Signature Company <br /> Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # �— <br /> 'LUMBER <br /> iignature Company <br /> Address <br /> Registered Y/ N Fee Current Y/ N <br /> AECHANICA License # <br /> iignature Company <br /> Address <br /> Registered Y/ N Fee Current Y/ N <br /> ITHER <br /> License # <br /> ignature Company <br /> Address <br /> Registered Y/ N Fee Current Y/ N <br /> irections: License # <br /> Fill out application completely <br /> Owner & Contrector sign back of application, notarized (Or, copy of signed contrect 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 /> Parcel #- obtained from Property Tax Notice (http://appreiser.pascogov.com) <br />