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813-780-0020 City of Zephyrhills Fire <br /> Fax-813-780-0021 <br /> Permit Application <br /> � D�;3 kF;i�%;r�d <br /> ' Phone Contact for Permit g�3 gqg 8702 <br /> Owner's Name Earnest Peeples <br /> Owner's Phone Number 813 7$2 2ggg <br /> Owner's Address 5217 Gall Blvd. <br /> Fee Simple Titleholder Name r--.� �� � <br /> Titleholder Phone Number L <br /> Fee Simple Titleholder Address <br /> Job Address 5217 Gall Blvd. �� <br /> Lot# <br /> Sub Division <br /> Parcel# <br /> � Bio-Hazard Waste Storage-ANNUAL � <br /> � Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct � Hazardous Materiaf(Tier II or RQ Facility)AN►JUAL <br /> � Controlled Burn � Hood Instaliation <br /> � Emergency Generator<30 kw � <br /> � LP/Natural Gas-Installation <br /> Emergency Generator>30 kw � <br /> LP/Natural Gas-ANNUAL Sale "`� <br /> � Fire Protection Maintenance-ANNUAL � � <br /> Places of Assembly-ANNUA <br /> ❑ r y em� �n t er ❑ <br /> Sprinkler X ❑ ❑ X <br /> Recreational Burn � ^�� <br /> Fire Alarm � ❑ p ❑ � � Sparkiers % J <br /> Hood Cleaning � p � � <br /> � � Sprinkler System Installat ns <br /> Hood Suppress�on � ❑ ❑ p � � Standpipes(Sprinkler Sys) \ <br /> � Fire Alarm Installation � Torch Roofingffar Kettle � <br /> � Fire?umps � Waste Tire Storage ANNUAL �� <br /> � Fire Works <br /> � Flammable Application-ANNUAL <br /> � Valuation of <br /> Fuel Tanks <br /> QOther: � <br /> � <br /> Contractor -�' � <br /> Signature ,, Z����2�L l l � ���____._._.__,. Company Miken Fire Protection, Inc. <br /> Registered Y/N Fee Current Y/N <br /> Address 1019 Wildrose Drive-Lutz, FL. 33549 <br /> License# Z�� app��Z��� <br /> ELECTRICIAN� <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER <br /> Signature Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# �- <br /> MECHANICAL <br /> Signature Ccmpany <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> OTHER <br /> Signa;ure Company <br /> Registered Y/N Fee Current Y/N <br /> Address <br /> 7irections: 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 after submittal date. Parcel#-obtained from Property Tax Notice htt ://a <br /> ( p ppraiser.pascogov.com) <br />