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ei�-�eo-oo2o Ciry of Zephyrhills Fire Fa�c-813-780-0021 <br /> Permit Application <br /> Date Received 2/6/2013 Phone Contact for Permit 813 313 1611 <br /> Owner's Name Ze h rhills Police Station Owner's Phone Number �� � <br /> Owner's Address 6118 8th Street ZEPHYRHILL FL 33542-3504 <br /> Fee Simple Titleholder Name TiUeholder Phone Number ��� � <br /> Fee Simple TiUeholder Address <br /> Job Address � <br /> Lot# <br /> Sub Division 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 0 Hood Installation <br /> ❑ Emergency Generator<30 kw 0 LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL i <br /> G!l� <br /> Sprinkler ���I�� � Recreational Burn �r�V ( <br /> Fire Alarm � c ❑ ❑ � � Sparklers � <br /> Hood Cleaning � ❑ � ❑ � � Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ ❑ 0 � Standpipes(Sprinkler Sys) <br /> � Fire Afarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL Valuation of Project <br /> ❑ FuelTanks <br /> x0 Other Backflow <br /> Contractor Wanda Paradis Comp Sim lex Grinnell <br /> Signature Regist Y/N Fee Cui Y/N <br /> Address 4701 Oak Fair Blvd,Tam a FL 33610 License# <br /> ELECTRICIAN Company <br /> Signature � <br /> Regist�_Y/N Fee Cu Y/N <br /> Address — <br /> License# <br /> PLUMBER <br /> Company <br /> Signature Regist�_Y/N Fee Cu Y/N <br /> Address License# <br /> M EC HAN ICAL Company <br /> Signature � Regist�_Y/N Fee Cu Y/N <br /> Address — <br /> License# <br /> OTHER Company <br /> Signature Regist� Y/N Fee Cu 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 drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />