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Ci of Zephyrhills Fire Fax-B�s-�so-ooz� <br /> 813-�80-0020 � <br /> Perm�t Application <br /> Phone Contact tor Permit ��'l _. �q q 3 <br /> , .� - : C� <br /> DateRece�ved .. . __- -- -�::- ::_�-_�.-�::_�_�:,=r:�s:=_;�_e.-_:u:.�,� .. . <br /> __.-_..... <br /> _ _ : -, ._ ->.-s' _"__.-- <br /> y <br /> __.-_--:-,_-.:,.r.__:-.-�:-- :_..._ ---- Q ,L�y <br /> Owner's Name ��9 DUS Il.l�i �- <br /> n[.c�Tl OtiL S Owner's Phone Number P�3 7 09 `'�a 1� <br /> Gwner's Address �0 VO ��° L�r� r � ��" ` �_���� <br /> Titleholder Phone Number � � � <br /> Fee:S�mple Titleholder Name <br /> �=� Sin�piP�Tdi2hOltl0r Atld�2SS C r- <br /> - - s.'-_s,:-_i.:,?,:�.'=_���3�.=_.t�'tnxs=�°-°_ r�s�'':'}�'�'zk.=c�'C3a�= � <br /> �93?� ,m�o,«c, �1�� ��r ���r��ccs �o�# <br /> ,i�b address � <br /> Sub DiwsiOn � -= =- �_„—�- �'_�--�;�r;:: ==�::..r_`-.___.__. <br /> . �___ ...,...... _ :_.. _....�.._,_�.,...___ _�.�.x.v� <br /> .. _:, ._.-,�..:-:�f -� _ <br /> ParCe <br /> .. :�:.:,_ ;��. �.. <br /> � Bio-Hazard Waste Storsge-'ANNUAL'v Y� i Q Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Comm Exhaust Kitchen Hood/Duct � Hood Installation <br /> � Conirotled Burn � LPINatural Gas-Instailation <br /> � Emergency Generator��30 kw � LP/Natural Gas-AIJNUAL Sale <br /> � Emergency Generator:>30 kw � Places of Assembly-ANNUAI <br /> oFire Protection Maintenance-ANNUAL Q Recreational Burn � <br /> ❑ try em� � er ❑ � � <br /> Sprinkler ❑ ❑ 0 Sparklers � <br /> Fire Alarm � ❑ � U � � Sprinkler System Installa ions � � <br /> Hood Cleaning � ❑ � � � � Standpipes(Sprinkler Sys) <br /> Hooc Suppression � � � ❑ � � Torch RoofinglTar KetUe <br /> � Pire Alarrn Installation � Waste Tire Storage ANNUA� <br /> � Fire Pumps <br /> Fire Works � <br /> � Ffammable Application-ANNUAI Valuation of Project <br /> FuelTanks ---, <br /> � Other: � a.� ._ - - �---_- -- ----- - <br /> - '. -.-=.:c.,.�`r_..._-�,,..._:-. _ :..�.�._-�:��_ .�':�:'r..�'��ag'r"*�e+.r'��=`.scs=�•-- - -- ..�- "_".. <br /> ,_....::... �..�-�_ .. <br /> - " "'"'.:�, ._ ..... . _ �..:. :_,,._ ... <br /> _:.". � _�y..� :� <br /> ... ._. _ :.�.:�._,u-��__�..�.�._:_._.�._._ __ <br /> Contractor � ' Company �^ � �u�'1'O n <br /> Signature <br /> Registered Y/N Fee Current Y!N <br /> Address 3 5 31 1�e ,�,on�2. Rc1• License# �F 000 y! <br /> t.LECTRiC�AN Company <br /> ��gnature Registered Y/N Fee Current Y J N <br /> Address � License# <br /> ;��uht��R �— :;ornpany i <br /> S�gnarure � � Registered Y/N Fee Curcent Y/N <br /> Adaress �� License# <br /> M EC HA N 1 CA L Company <br /> $ignature <br /> Registered Y!N Fee Currant Y/N <br /> Aodress License�t <br /> oTH�R � � Company � � <br /> ��gnature Registered Y I N Fee Current Y i� <br /> Ar,dress LiCense# <br /> U��BC:10115 <br /> F�II�iut application completely <br /> Owner&ConVactor Sign back of application,notarized(Or,copy of signed contract wdh owner) <br /> tf over S2500,a Notice of Commencement is requfred(Mechanical work over 55000) <br /> Supply two(2)seis of drawings with app��cable documeniation <br /> Allow 10-14 days for review aft�r submittal date. Parcel#-obtained irom Propsriy Tax NoUce(http://appraiser.pasCOgov com) <br />