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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 I
<br /> Permit Application , �
<br />� Date Received ,�^ Phone Contact for Permit yo� �7 �,SO K��
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<br /> Owner's Name J � E /LS 71�j ' Owners Phone Number � � �
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<br /> Owner's Address �s.�p �L B L1�Q• �
<br /> Fee Simple Titleholder Name � Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address I 1
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<br /> Job Address MS�3 8 L[. �L1�Q r �I YLot# ��
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storege-ANNUAL I �� Fumigation Tent
<br /> Comm Exhaust Kitchen Hood/Duct �����`i a Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation
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<br /> I � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> I � Emergency Generator>30 kw I � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � � Places of Assembly-ANNUAL
<br /> t y emi �n t er
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum _ p
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<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers I '-) 2 �
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<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations , I/'�(�
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<br /> Hood Suppression � ❑ ❑ O � � Standpipes(Sprinkler Sys) �`
<br /> � Fire Alarm Installation i � Torch Roofing/Tar Kettle /
<br /> � Fire Pumps i � Waste Tire Storage ANNUAL /1�/��
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<br /> � Fire Works '
<br /> � FlammableApplication-ANNUAL I 3 Z pOO,% Valuation of Project
<br /> � Fuel Tanks �
<br /> Q Other: I
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<br /> Contractor � � � Company o•�l �/6 �G /J�•
<br /> Signature � � Registered Y/N Fee Current Y/N
<br /> Address 'fs'O UNrVgitSst BLt(�, P.✓'tnTt'� �thl '�'t. License#
<br /> ELECTRICIAN � � i Company f1�1�"U4��✓ E'�T2'M'� , � ,�1/C
<br /> Signature � Registered Y/N Fee Current Y/N
<br /> Address � License#
<br /> PLUMBER I Company
<br /> Signature � Registered Y/N Fee Current Y/N
<br /> Address 1� License#
<br /> MECHANICAL I Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> ddress � License#
<br /> OTHER � Company
<br /> Signatur Registered Y/N Fee Current Y/N
<br /> ddress . ; License#
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<br /> Directions: I
<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. : -,• PaPceli#-obtained frorti,Property Tax Notice(http://appraiser.pascogov.com)
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