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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> :� '� '�= Permit Application
<br /> Date Received ;, �'�p— l� Phone Contact for Permit
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<br /> Owners Name ` f� Owner's Phone Number � � ���a.,
<br /> Owner'sAddress ��d � � � �y �� +�H-� �S —(� �j �jS �_
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address I
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<br /> Job Address � 1 J �11`�� 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/Naturai Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL
<br /> �y emi �n er
<br /> Sprinkler � ❑ ❑ ❑ B � Recreational Bum
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers ! �(�
<br /> Hood Cleaning � ❑ � ❑ � � Sprinkler System Installations /� I�t��J �
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<br /> Hood Suppression � ❑ O ❑ � � 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 /> Q Other:
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<br /> Co�ntractor y/��n\���1^, , ` Co9 pany
<br /> Si nature � v "� Re istered 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#
<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 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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