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' s�3aso-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> _ Permit Application <br /> Date Received - � Phone Contact for Pertnit �,'�52 '� 7 7340 <br /> Owners Name Dominos Pizza Ownefs Phone Number ���� <br /> Owner's Address 5050 Gall Bivd Ze h rhills, FI <br /> Fee Simple Titleholder Name Titieholder Phone Number $13 748 7702 <br /> Fee Simple Titleholder Address <br /> Job Address Lot # � <br /> Sub Division Parcel # <br /> � Bio-liazard Waste Storage - ANNUAL � Fumigation Tent <br /> O Comm 6chaust Kitchen HoodlDuct � Hazardous Material (Tier II or RQ Facility) ANNU�L_ <br /> � Controlled Bum � Hood Installatian <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw Q LP/Nahxal Gas-ANNUAL Sale �/� <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL /�, J <br /> Z y em� �n er <br /> Sprinkler � ❑ ❑ � � Recreational Bum <br /> Fire Alartn � ❑ ❑ 0 � � Sparkters . <br /> Hood Cleaning � O ❑ ❑� � Sprinkler System Installations <br /> Hood Suppression � ❑ C9 ❑� � Standpipes (Sprinkler Sys) <br /> � Fire Alarm installation � Torch Roofing/Tar Kettle <br /> Fire Pumps � Waste Tire Storage ANNUAL <br /> F2 Works <br /> Flammable Application- ANNUAL � Valuation of Project <br /> � Fuel Tanks <br /> Q Other. <br /> Contractor ���Y <br /> Signature Registered Y/ N Fee Current Y J N <br /> Address License # <br /> ELECTRICIAN Company � <br /> Signature � Registered Y/ N Fee Curcent Y/ N <br /> Address Licersse # <br /> PLUMBER Company �- <br /> g� Registered _ Y! N Fee Current Y/ N <br /> Address License # <br /> MECHANICA C�Pa^Y <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address Lice�e # <br /> OTHER C � Company Securit Fire E ul ment LLC <br /> Signature Registered Y/ N Fee Curtent Y/ N <br /> Address 18 3 3 0 Lawrence Rd uce^se # <br /> Directions: <br /> FII out application completely. <br /> Ownet & CoMractor sign back of application, notarized (Or, copy of signed coMract with ovmer) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over 55000) <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:/tappraiser.pascogov.com) <br />