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813-780-0020 City of Zephyrhills Fire <br /> Pertnd Applicahon Fa•-ai�-�eo-oozi <br /> Date Received 2/6/2013 Phone Contact for Permit 813 313 1611 <br /> Owner's Name Waste Water Treatment Plant Owner's Phone Number �� � <br /> Owner's Address 39825 Alston Avenue 2EPHYRHILL FL 33542-6733 <br /> Fee Simple Titleholder Name Titleholder Phone Number �� � <br /> Fee Simple TiUeholder 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 /> Fire Alarm ° X � � Recreational Burn <br /> � ° ° ° � � Sparklers �G�`�� <br /> Hood Cleaning ❑ ❑ ❑ � � Sprinkler System Installations \� <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> ❑ Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> Fire Works <br /> � Flammable Application-ANNUAL �� <br /> ❑ Fuel Tanks Valuation of Project <br /> x0 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 � Compa� <br /> Regist�_ Y!N J Fee Cu Y/N <br /> Address - <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Regist� Y/N � Fee Cu Y/N <br /> Address <br /> MECHANICAL License# <br /> Signature � Company <br /> Regist�_Y/N � Fee Cu Y/N <br /> Address <br /> License# <br /> OTHER <br /> Signature Company <br /> Regist�_Y/N � Fee Cui Y/N <br /> Address <br /> Directions: License# <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(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 Pro e Tax Notice htt //a <br /> P rtY ( p: ppraiser.pascogov.com) <br />