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ata-7eo-oo2o City of Zephyrhills Fire <br /> Permit Application Faz-813-760-0021 <br /> Date Received 2/6/2013 Phone Contact for Permit 813 313 1611 <br /> Owner's Name Ze h rhills Fire Station#1 Owner's Phone Number �� � <br /> Owner's Address 6907 Dai Rd�Attn:Lor ZEPHYRHILL FL 33542-1631 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple Titleholder Address <br /> Job Address � <br /> Sub Division Lot# <br /> 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 Installation <br /> ❑ Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> ❑ Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL ��/� <br /> Sprinkler ����'� �� <br /> ° ° X � � Recreational Bum �� <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � � � � <br /> ❑ � � Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> ❑ Fire Alarm Installation �� Torch Roofing/Tar Kettle <br /> � Fire Pumps O Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application-ANNUAL <br /> ❑ Fuel Tanks Valuation of Project <br /> � Other Backflow <br /> Contractor Wanda Paradis Comp Sim lex Grinnell <br /> Signature <br /> Regist Y/N Fee Cu Y/N <br /> Address 4701 Oak Fair Blvd,Tam a FL 33610 License# <br /> ELECTRICIAN <br /> Signature � Compay <br /> Address Regist�_Y/N � Fee Cu Y/N <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Regist Y/N Fee Cu Y/N <br /> Address <br /> MECHANICAL License# <br /> Signature � Company <br /> Address <br /> Regist�_Y/N Fee Cu, Y/N <br /> License# <br /> OTHER <br /> Signature Company <br /> Registd_Y/N Fee Cu Y/N <br /> Address — <br /> Directions: License# <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 drawings with applicable documentation <br /> Allow 10-14 days for review aker submittal date. Parcel#-obtained from Property Tax Notice htt //a <br /> ( p: ppraiser.pascogov.com) <br />