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. a�s-7a,o-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Da�te Received Phone Contact for Pertnit <br /> ._-s,.�.���, , r :���..�..__._..�.����::����:<-.�...�:��.. <br /> ...��+_..�����•..�� <br /> Owner's Name /LT(r�}�./� d Z ��,t } Owner's Phone Number �� � � <br /> Owner's Address 3�C�.Z.Q �l"�+v� �.it� <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � I � <br /> Fee Simple Titleholder Address �---� <br /> u - . _ • �,. <br /> . .�a� s.-a��:� . :�,��9==.��n�.��. � <br /> Job Address 3 Z� �-�g ��/� (J:2 <br /> Lot# � <br /> Sub Division Parcel# <br /> p.� y. .� tic.nw.6., .x.ecx.ti.l""s'f-���:e#Z __ _-0�^Y�'+:§$'�%.*'�'§TMYt,. 'Y`R.'+'^^#+�"" ' _ " <br /> `.'gp,?B*a'�At.Y':trw..,.;,-r.ss-�m�:>c.Y3.. z �d��� �a,.iur..-t.-a=�...r>��,5»,.:.3r,..� :9t'sw°'!U�«Q`v��"x�,tt'�"'�,e,... �.`"n u^?.+�.5,.,>�,,gyA�` <br /> 0 4 �� � �...k. � <br /> Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Instatlation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale ��j�i/3�� <br /> � Fire Protection Maintenance-ANNUAL � �� � <br /> Places of Assembly-ANNUAL <br /> ❑ RTr y emi �n er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> Hood Suppression � ❑ :� ❑ �� � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of Project <br /> Fuel Tanks <br /> Q Other: � <br />�. - - ,���.- . A , .. x.. � <br /> . �,. . ....... <br /> _.:>�;�-�. .._ ;, <br /> Contractor /' <br /> Signature lfi��`Q�l.�-� �i/Cip�.,TCb v�) • CompanY �v��.( 6-("'�. ,�LC;TC—LTI� <br /> � Registered Y/N Fee Current Y/N <br /> Address "�� <br /> License# <br /> ELECTRICIAN <br /> Signature <br /> Company <br /> ° Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> 5ignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> UECHANICAL <br /> iignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br />�THER <br /> iignature <br /> Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> , License# <br />>irections: <br /> Fill out application completely <br /> Owner 8,Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanicai 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 Pro <br /> perty Tax Notice(http:Happraiser.pascogov.com) <br />