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' sisaao-oo2o City of Zephyrhills Fire <br /> Permit Application Fax•813-780-002� <br /> Date Received - ' <br /> - - _ Phone Contact for Permit �,Y� qL.�z �q�3 <br /> Owner's Name ��/yT`/A� C2 /y/�NO� ��� �� � <br /> a ��� Owner's Phone Number � <br /> Owner's Address Q �a� �/f/ y �� �–��/� / f_� 2�S�� � <br /> � �� � <br /> Fee Simple Titleholder Name � ((��''--------�� <br /> Fee Simpie Titleholder Address Titleholder Phone Number �� � <br /> �.J <br /> �:...T.- __T_ ,.__,. ..s. _-_�..,.. <br /> JobAddress 3�aao �uQS/ �,� wJ�–�ILCs �L ��r51�� <br /> Sub Division <br /> Lot# � <br /> Parcel# � <br /> � Bio-Hazard Waste Storage-ANNUAL � � <br /> ❑ Hazardous Material(Tier il or RQ Facil ty)ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct Q <br /> Q Hood Instailatian <br /> Controlled Burn a <br /> ❑ LP/Natural Gas-Instailation <br /> Emergency Generator<30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Emergency Generator>30 kw � <br /> � Places of Assembly-ANNUAL <br /> Fire''rotection Maintenance-ANNUAL � <br /> try e�pi � ef Recreational Burn <br /> Sprinkler a t( � � ❑ <br /> Sparklers <br /> Fire Alarm ❑ ❑ n � � <br /> ❑ Sprinkler System Instaliations <br /> Hood Cleaning � C � � ❑ <br /> ❑ Standpipes(Sprinkler Sys) <br /> Hood Suppression � � � � ❑ <br /> � Torch RoofinglTar Kettle <br /> Ffte Alarm InStallati0n � <br /> ❑ Waste Tire Storage ANNURL <br /> Fire Pumps <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Fuel Tanks Valuation of Project <br /> [� Other <br /> Contractor -- � - -- - - .-. :..,_ <br /> Signature Company -�-- ' , <br /> Registered Y/N Fee Currenr V I N �— <br /> �adress 353 i I� �on -- ��_' ' � <br /> CLECTRICIAN Ucense# q 3 � 1� z <br /> Signature Company �— <br /> Address <br /> Registered Y/N Fee Current Y/N <br /> Pl UMSE R ��cense# � <br /> Signature Company <br /> Registered Y/P� Fee Current � <br /> Add!ess Y/N <br /> MECHANICAL License# � <br /> Signature Company —' <br /> Address Registered Y/N Fee Current Y/N --'� <br /> vTHER � <br /> License# ��--� <br />:�gra!ur� � Company <br /> Address � Registered Y/N Fee Current Y/N <br /> CirecSon; - - 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 32500,a NoUGe of Commencement is required(Mechanicai work over 55000) <br /> Supply two(2)sets o#drawings with applicabie documentation <br /> Allow 10-14 days for review after submittai date. Parcei#-obtained from Proper,y Tax Notice(http:/lappraiser.pascagov com) <br />