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' 813-i8o-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone contact tor Permit EMI I 31, I 140'53 <br /> ' <br /> Owners Name 1 St '00t)ph s Ca fimi f'c_ cliardi I Olirier's Phone Number [1E3 11111 cif =1 <br /> Owner's Address I <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> . . <br /> Job Address IIIVIZWAL th A0e Lot# <br /> Sub Division .il 6 Parcel# <br /> . : <br /> El Bio-Hazard Waste Storage-ANNUAL ED Fumigation Tent <br /> ElComm Exhaust ICedien Hood/Duct ED Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> EDControlled Bum ED Hood Installation <br /> E3Emergency Generator<30 kw R LP/Natural Gas-Instigation <br /> EDEmergency Generator>30 kw LP/Natund Gas-ANNUAL Sale <br /> ED Fre Protection Maintenance-ANNUAL El Places of Assembly-ANNUAL <br /> RE 11 BEI LtiL. 1 <br /> Sprintder Li 0 0 0 RRecreationalBurn <br /> Fire Alann Et 0 0 'at I I Sparlders <br /> i <br /> Hood Cleaning 0 0 0 R Sprinkler System Mitigations <br /> Hood Suppression El 0 0 0 Standpipes(0Prielder Sys) <br /> EDFire Alarm installation [ J Torch RoofingITar Kettle <br /> Fire Pumps <br /> ED Waste The Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> ED Other <br /> . . <br /> Contractor , .. . Company •L121111111111. ectri • wearizarzon <br /> Signature -N'--2,-1 ,--23:, _. - -----,-- — ------ _. Registered Y/N Fee current YIN <br /> Address 111111115/M1110=1111111EMETINECIIIIMINIINIIII License* rT7770F517"--1 <br /> ELECTRICIAN Company <br /> Registered Y/N I Fee Current I YIN I I <br /> Address License# I <br /> PLUMBER Company I <br /> Signature Registered YIN 1 Fee Current I YIN <br /> Address I License tt <br /> MECHANICAL Company I <br /> Signature Registered YIN .I Fee Current I YIN I <br /> Address License S <br /> OTHER Company I <br /> Signature Registered YIN J Fee Current I YIN I <br /> Address License# <br /> Directions: <br /> FM out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with wrier) <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 ft-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br />