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<br /> 8�saao-oo20 , City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received � ,-'��—` � Phone Contact for ermi i 2� Cp`1� �1 a'�,
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<br /> Owners Name � � Owner's Phone Number ����D "1�� � 02
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<br /> Owner's Address
<br /> Fee Simple Titleholder Name I Titleholder Phone Number � � ��
<br /> Fee Simple Titleholder Address � I
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<br /> Job Address Lot#
<br /> Sub Division `� p� Z.e � (`��`t S Paroel# �� ' 26�2� -���� �l��
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<br /> - ._
<br /> � �Bio-Hazard Waste Storage-ANNUAL '� Fumigation Tent� I�
<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-APINUAL 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
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> I � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Fire Works
<br /> � Flammable Application-ANNUAL 'Zl.��, Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other: I
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<br /> Contractor � Company ��. �j2.��� �-(°r
<br /> Signature --,�—�- Registered Y/N Fee Current Y/N
<br /> Address �-1� � ��-+ l S r r�� License# C.�_� ���
<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#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address � License#
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<br /> Directions:�.�:_. ..�...___ .._..r-1..._;�.._-
<br /> Fill out application completely.
<br /> Owner 8 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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