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a�3-�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date ReceivedP 1/30/2012 Phone Contact for Permit 813 313 1637 <br /> Owner's Name Waste Water Treatment Plant owner's Phone Number C 813 780 0029 <br /> Owner's Address 6907 Dairy Rd.,Zephyrhills, FL 33542 <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � � <br /> Fee Simple Titleholder Address <br /> �J <br /> JobAddress 39825 Alston Avenue ZEPHYRHILLS FL 33542 � �oc# � <br /> Sub Division Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood InstalFation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale . (��, <br /> � Fire Protection Maintenance-ANNUAL � ��V <br /> Places of Assembly-ANNUAL I � <br /> tr y emi � t er ❑ <br /> Sprinkler � ❑ ❑ �Y'--� <br /> �X Recreational Burn <br /> Fire Alarm ❑ ❑ ❑ � � Sparklers <br /> Hood Clearnng � ❑ C ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ ❑ ❑ �� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> 0 Other (1)Annual backflow inspection& (1)Annual Wet sprinkler inspection <br /> Contractor / ` �� Company SimplexGrinnell <br /> Signature ��� ��.Y C.tV Registered Y/N Fee Current Y/N <br /> Address 4701 Oak Fair Blvd , Tampa, FL. 33610 �icense# <br /> ELECTRICIAN <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Registered Y/N Fee C;urrent Y/N <br /> Address <br /> License# <br /> MECHANICAL <br /> Company <br /> Signature Registered Y/N Fee C:urrent Y/N <br /> Address <br /> License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee C'.urrent Y/N <br /> Address <br /> License# <br /> Directions: <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 reqwred(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 />