HomeMy WebLinkAbout22-4384City of Zephyrhills
5335 Eighth Street
Zephyrhills, FIL 33542
Phone: (813) 780-0020
Fax: (813) 780-0021
IMMUNE IIIII III iiiiiiiiiiijill'Ilill111111111111111111 11111 1
Mlfflllffi I I !I I IN Mill III III 1 1!11111
FIRE-004384-2022
Issue Date: 08/08/2022
accordance with City Codes and Ordinances. N6'OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
m
813-780-0020 City of Zephyrhills Fire Fox-813-780-0021
Permit Application
Date Received Phone Contact for Permit
Owners Name I _Z
Fee Simple Titleholder Name
Fee Simple Titleholder Address
Titleholder Phone Number
ME
Blo-Hazard Waste Storage - ANNUAL
E]
Fumigation Tent
Comm Exhaust Kitchen Hood/Duct
Hazardous Material (Tier 11 or RQ Facility) ANNUAL
Controlled Burn
Hood Installation
Emergency Generator < 30 kw
LP/Natural Gas -installation
Emergency Generator > 30 kw
LP/Natural Gas -ANNUAL Sale
Fire Protection Maintenance - ANNUAL
Places of Assembly -ANNUAL
41
Sprinkler El 11
0 0
Recreational Bum
Fire Alarm El
0 rJ
LJ
Sparklers
Hood Cleaning EJ Cl
0 0
0
Sprinkler System Installations
Hood Suppression Gi
L
r ------ I
Standpipes (Sprinkler Sys)
Fire Alarm Installation
Torch Roofing/Tar Kettle
Fire Pumps
Waste Tire Storage ANNUAL
Flammable Application- ANNUAL
Valuation of Project
Fuel Tanks
Other:
'ontractor
Company
Fee �CwTnt
Signature
Registered Ej;
Y t N��
Address
License #
ELECTRICIAN
Company r
Signature
Registered hZN
Fee Current 1��
Address
License #
M
Signature
Address
OTH
Signature
Address
Company
Registered
License #
Company
Registered
License #
Company
Registered N§5�aFe Current
License #
. 1
Fill out application completely.
Owner & Contractor sign back of application, notarized {Or, copy of signed contract with owner)
If over $2500, a Notice of Commencement is required (Mechanical work over $5000)
Supply two (2) sets of drawings with applicable documentation
Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http://appraiser,pascogov,com)
WARNING TO OWNERYOUR FAILURE TO RECORD A NOTICE OF COMMENCEN!"T MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITHI YOUR LENDER OR ANATTORNEY BEFORE RECORDING YOUR NOTICE Or COMMENCE
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGEN-�_ CONTRACTOR
Subscribed and sworn to (or affirmed) before me this Sub ribed and sworn (or affirmed) b r t
—by ;Z=y h4w ki ,
Who —is/are p;rsonally known to me or has/have produced Who is/are or haslhave pr—od—uc—ed
as identification. as identification.
Notary Public
012MM=
Name of Notary typed, printed or stamped
Notary Public
Commission No,& ar
Day -CA 1� 0,ise'L_
Name of Notary typed, printed or stamped
Notary Public Scat p of ploridq
Dana Kossel
MY Commission GG 293360
Expires 02103/2023
saas
—M �T -
0 �- I —A
ISM=
017n CLEM"
MEM
I - — I
i