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s��-7aa-ao2o �� City of Zephyrhills'Fire� Fax-8t3-78o-o021 <br /> � , /,. Permit Application <br /> � � /,�------_... <br /> )ate Received ��{..:.LL.� - r � Phone Contact for Permit ����C.—]T� <br /> v�,ws:..,-<e�.,..;i�:�� �-�a�c�.��::�����-ass��.•-'�.—.�.—� - <br /> hvner's Name �, `i V Owne�5 Phone Number C� C� � <br /> )wners Address � "'� '�-� ; S � � <br /> =ee Simpl=Titleholder Name TiHeholder Phone Number � � � <br /> =ee SimpleTitleholderAddress <br /> �.,�,"aMs�`i��":��e�1.�'.f�i� s s .o• <br /> S� -a'"�'- -�pc'u"�`'3'Ys�siw�s's�w`.f3a�.�:�!°�;,.�'+a�r�x��+ <br /> JobAddress � • {' j ` � �-�� Lot# C <br /> Sub Division Q Parcei# � L ..� 0 - ���U <br />'a�:7•:-�?�'>.s�.'a.�:�...�,,,.��.��.�,� e� ,�..--:'- <br /> . `�3,}F.u�e:�F"�i�Ct;szH� ��.�1Lr^'�1:::���..=��..-.+f�`-rs-"�,*:S� <br /> � Bio-Hazard Waste 5torage-ANNUAL � Fumigation Tent <br /> � Comm 6chaust Iqtchen Hood/Duct a Hazardous Material{Tler li or RQ Feciliiy)ANNUAL <br /> � Conirolled Bum � Hood Installatlon <br /> � Emergency Generator<30 kw � LP/Naturel Gas-Instaflation <br /> Emergency Generator>30 kw � LPlNatural Gas-ANNUAL Sale <br /> Fire Protection Mairrtenance-APiNUAL � Places of Assembly-ANNUAL <br /> r y emi �n ar ' � .3 7�� <br /> Sprinkler � ❑ p O � � Recreational Bum � � ` � <br /> Fire Alartn ❑ ❑ S�h � � Sparklers J� <br /> .✓ <br /> Hood Cleaning ❑ p ,O � a Sprinkler System Instailatlons �_ <br /> Hood Suppression � p ❑ O �� o Standpipes(Sprinkler Sys) <br /> aFirc�Alartn installation � Torch RaofingfCar Kettle <br /> ' Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Applicatlon-ANNUAL � Valuation of Project <br /> Fuef Tanks <br /> � Other: <br /> 3�.� - ,��3:��. ���s��rd,:���.°� <br /> Contractor " � <br /> ComParry ' � :�- > �' n.� 'ir�'���'►ts, <br /> Signature �, _ ' Registered Y N Fee C:utTent Y � <br /> Address � �c � _ "'3 �- <br /> � r'° License'� F F �J J c: �i3 H � <br /> ELECTRICIAN Company � <br /> 5ignature Registered Y!N Fee C;urrent Y/N <br /> Address --y <br /> License# � <br /> PLUMBER Company <br /> 5ignature Registered Y/N Fee Gurrent Y/N <br /> Address <br /> License# �— <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee c:urrent Y/N <br /> Address —� License# �— �� <br /> OTHER <br /> Compeny <br /> Signature Registerad Y/N Fee(:urrent Y/N <br /> Address <br /> . <br /> �a.u��-�+-=-.... �� .,..,,, ��..,:�.�..,......�..:vasan�icense# <br /> Dire ' <br /> ---,...a _., ..�,,;:.._. •- ...,�- <br /> c tons: --- - - ^'�-_�--'�— -_�..��t�,......,�- <br /> Fill aut appllcation completely. <br /> Owner 8 Contractor sign back of applicatior�,notarized(Or,copy of signad contract with owner} <br /> If over$250D,a Notice of Commencement is required(Mechanica!work over a5000) <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:!/appr�isar.pascogov.cam) <br />