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813-780-0020 Ciry of Zephyrhills Fire Fax-813-780.0021 <br /> , Permit Application <br /> Date.Received �(L—/L Phone Contact for Pertnit E3 (.3 q g b Lc-�(o <br /> Owners Name S o�n S Q13 Q Owners Phone Number � �3 78,Z. l.{ g'7' <br /> Owner's Address (g(o C7(o �-a...�( 1�(,.f� � �-(�,��( �( g-���..�Z <br /> Fee Simple Titleholder Name Titleholder Phone Number C� C� �� <br /> Fee Simple Titleholder Address <br /> . «`�k:�=., �:�s`z?;;�.:arr:���sz��e=°�r., ��x -*' . . :a..Nm,t�:'r�,�,4'�k:<'�:r,���-��:�::°� � . _ <br /> Job Address j(�r(/V�-e-- �� <br /> Lot# <br /> Sub Division Paroel# <br /> . .. t.t.a°:�%F.' + i?"�0.- .;D.' ,:iw.. i�,.:5'::�CkF'�,Y:Y,.F::s.,... ... . . " > <br /> ., n, q .-..�... ,. , , rs-'$;:.c,.i$3.:b:'4Gk't' a`F.$�,•t.i:. <br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent }`` Y,• X ^ . '- , ` ( <br /> � Comm F�chaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw a LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum <br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � p ❑ ,$j � a Standpipes(Sprinkler Sys) <br /> � Fire Alarm I�stallation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storege ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> , . . :,� ��..,: � - - - ., . „ . �... � .. , � , �,� . . . <br /> Contractor Com an <br /> P Y �'r� � �f.Cl' /.-t c_ <br /> Signature Registered Y/N Fee urrent Y/N <br /> Address O D ' /3�/63Q License# <br /> ELECTRICIAN Company <br /> Signature � Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICA Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> OTHER <br /> Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address 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 required(Mechanical work over$5000) <br /> Supply two(2)sets of drewings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tvc Notice(http://appraiser.pascogov.com) <br />