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813 780-d420 City of Zephyrhills Fire Fax-813-780-0021
<br /> ,. , � Permit Application
<br /> Date Received �2.�,�1 Phone Gontact for Permit C�_�� ��
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<br /> Ovme�s Name � � ,' �n . p� Owne�s Phone Number � � ��
<br /> Owners Address „� / / �'�+ /'�V e
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titieholder Address
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<br /> Job Address lof# ��
<br /> Sub Division Parcel#
<br /> £,._ �_.._�.,d_�.�._.._:n.:_��._.._......� n.,..s�v_-� .,.,.._v._.�.,�..,..._.a��..___....--^��:A.,.._,---_.__..�.�..,.W..�__...:..,,_�,�,_�-�w__°____...._�_°_...�.Y_._,...._.._�..-.�.��...,�_..�_�._.—�
<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Gomm E�aust Kitchen Hoodlduct Q Flazardous Materiai{Tier II ar R{2 Facility}ANNUAL
<br /> � Controlled Bum a Hood Installation
<br /> � Emergency Generator<34 kw � l.P/Natuta!Gas-tnsEaltatian
<br /> QEmergency Generator>30 kw !.P/Natural Gas-ANNUAL Sale
<br /> � Fire Protectian Maintenance-ANNUAL Places of Assembly-AI�tNUAL "'
<br /> ❑� emi � t er � n/,��'{
<br /> Sprinkier C3 � ❑ FtecreationaE Bum j �l � ��
<br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers � �
<br /> Hood Gleaning � ❑ ❑ ❑ � � 8prink(er System Installations ���
<br /> Haad Suppression ❑ d ❑ Standpipes(Sprinkler Sys) �
<br />��� � � ❑
<br />� � Fire Atarm Installatton Q Torch RoofingtTar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � FlammablsAppliaatian-ANNUAL �� —, Valuation af Project
<br /> � Fuel Tanks
<br /> Q Qth2t:
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<br /> Confracfor Company
<br /> 8ignature Registered Y/N Fee Gurrent Y/N I
<br /> Addrass �ieense#
<br /> ELECTRICIAN Company
<br /> Signature Registered Y 1 N Fee Current Y/I�
<br /> Address License#
<br /> PIUMBER Company
<br /> 8ignature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MECHANICAL Company
<br /> Signature Registered Y I N Fee Current Y 1 N j
<br /> Address License# �
<br /> �
<br /> OTHER Company I
<br /> Signature Registered Y/N Fee Gurrent Y/N �
<br /> Address License# '
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<br /> Directions:`_.__._.�___._�...._,:.._..,..�._.�_. .___,�,._-._._«.._�._,._._..__------- -
<br /> Fili out application complefely. ,
<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{Mechanicai work over$5044) �
<br /> 1
<br /> Supply two(2}sets of drawings with applicable documentation '
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained fram Property Tax Notice(http://appraiser.pasaogov.com)
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