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a��-7ao-oo2o City of Zephyrhills Fire Fax-813-780-0021
<br /> �� Pe�mit Application
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<br /> Date Received �- �0� ( 5� Phone Contact for Permit R I � , ���- ��
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<br /> Owner's Name � ��2 ,r /Z 5��-- R��.�-vL�- Owners Phone Number 3 7c�oZ � �j�-�' �
<br /> Owner's Address � L U � l� Y�tL�- ��✓� �� �{ E�l-l��-.� �(.� 3,3 S �-
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address �
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<br /> Job Address �,1��I�� (Ti�t L�' �'�� � � Y ,�►L�l ���L .�3 �T�a — -- Lot# �
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � 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 /> tr y emi � t er
<br /> Sprinkler � ❑ ❑ ❑ I � Recreational Burn
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<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 Valuation of Project
<br /> � Fuel Tanks
<br /> � Other: C.0 � �vtn�L.�
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<br /> Contractor � Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
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<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
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<br /> Directions:�
<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 Comme�cement is required(Mecha�ical 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(http://appraiser.pascogov.com)
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