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s�3-�so-oozo City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> ate Received Phone Contact for Permit � 3a q J OO <br /> wner's Name �� Owner's Phone Number °� 7 g a �Z <br /> wner'sAddress � ��� Z ��� ��'S L 34� �9 <br /> �e Simple Titleholder Name Titleholder Phone Number r �� <br /> �e Simple Titleholder Address <br /> �b Address K�C. 55 � 1.� � 1 vd L «'1t �'S '� 7Z Lot # � <br /> �b Division Parcel # <br /> � Bio-Hazard Waste Storage - ANNUAL � Hazardous Material (Tier il or RQ Facilky) ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct a Hood Installation <br /> a Controlled Bum � LP/Natural Gas-Installation <br /> � Emergency Generator < 30 kw � LPMatural Gas-ANNUAL Sale <br /> � Emergency Generator > 30 kw � Places of Assembiy-ANNUAL � <br /> Fire Protection Maintenance - ANNUAL � Recreational Bum � <br /> �r emi �n er � � <br /> � `., � C"�1 Sprinkler � ❑ ❑ ❑ � � Sparklers '� <br /> SG � <br /> � j z� �� Fire Alarm � � ❑ ❑� � Sprinkler System Installations <br /> O p jVD�M Hood Cleaning �� ❑ ❑� � Standpipes (Spri�kler Sys) <br /> / <br /> Hood Suppression � ❑ ❑ ❑� � Torch Roofing(far Kettle <br /> � Fire Alartn Installation � Waste Tire Storage ANNUAL <br /> � Fire Pumps <br /> � Fire Works <br /> � Flammable Application- ANNUAL Vafuation of Project <br /> � Fuel Tanks <br /> Q Other: <br /> �ntractor Q � N � 1 ��) � �� Company <br /> gnature �� Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> _ECTRICIAN �j� Company <br /> gnature �����^P a�'^ es S Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> _UMBER Company <br /> gnature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> ECHANICAI� � Company <br /> gnature Registered Y/ N Fee Curre�t Y! N <br /> S�C. <br /> Address CV1GIl �& E Clean �13368$ � License # <br /> C ood �$ o o amp 3 3 g9$$ <br /> ynature PO �13 9 r F • g1 "93 Regi e Y/ N Fee Current Y/ N <br /> Address CD' g License # <br /> irections: <br /> Fill out application completely <br /> Owner & Contractor sign back of appliption, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanipl work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Properly Tax Notice (http://appraiser.pascogov.com) <br /> P�1 ��L aa�°�Fl � ay 1-0 �aZy L.c,� � � C--I 3 i� ,F'� 3�c� �'� <br /> —� ----. <br /> n1a� ���y a�d�ss � Po 30� a7.�r��� �'�,P�, �- 33 �$�a <br />