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813-780-0020 City of Zephyrhills Fire Fax-81 - 8-9�1
<br />� Permit Application . \
<br /> Date Received 7 '3 S Phone Contact for Permit �(.' rp 2-Z
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<br /> Owner's Name �~ ,(`� t \ ��,yt 1 y� S' / I Owner's Phone Number � 1 �r5 �J ZZ J
<br /> Owner's Address � ( Z �4��
<br />� Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address �
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<br /> Job Address T��I �L � `���� �'�/� �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 �n t er
<br /> Sprinkler � ❑ ❑ ❑ I � Recreational Burn
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations '��'D�
<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 /> � FlammableApplication-ANNUAL Valuation of Project �
<br /> � Fuel Tanks
<br /> Q Other: �
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<br /> Contractor � Company y�, �', p� ' I
<br /> Signature • Registered Y/N Fee Current Y/N�
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<br /> Address 7 f E ,�7� / � „F �icense# ��.- �9Q$� Z� ,
<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 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(http://appraiser.pascogov.com)
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