|
813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> , , Permit Application _
<br /> Date Received � �
<br /> ��_�.-s-�•.-.�...r..,;�"�_.-�:,,.w-,� ,>�. > .-- �- � - -� >-- -
<br /> -..-,.,.., �-�„.,,_�_:.�:�:.�.a:�.:��nkK.t:,-_:�,:.�-_:�.,:-{���w-.�.;�.a. ,_.__ ... -... �___�'e..>.._._, ..._, ,.,.M-�__ .. _ � .> ...z...,,.,,..:.�.�..�, -
<br /> Ph Contact for Pe lt
<br /> �... -�-. :;�.,�...,�.Y: .�._.�:.:.:-. —t-„.��,Y�.. -�
<br /> Owners Name � � Ovmer's Phone Numb~ � �
<br /> �
<br /> Ovmers Address �-Y(/ �/� y� ��. �3•�' 3
<br /> Fee Simple Titleholder Name Titleholder Phone Number � � �
<br /> Fee Simple Titleholder Address ,
<br /> °azs;^�...,�,s��. �-- �,-�;r,�:,,.,-x.�->�z-K-�,,. -
<br /> . .,_. .. ... . ... ,.,: . :��;;,:e:w�.�.::.'`ra''., �;;�c:?:"��.""i�.�`.�''...�.�";- ...�.*' _^-- .�'-�,��-`=�.-�,r<,,t_...,.-+,'.r•,-..�-,--�r^>:-,-s:'--r. "^ -_t�;s�y::z--•ca-�=
<br /> .m::?:w".,.v:��'tu:='�i�.. J:...L.. v�sa.... ���,,::a.<.,,_...t:_.._'�t`�'.�.;'.�.,�.1.:�'.::s�, "�_�
<br /> Job Address ��� � �I I� � 5 l� ' Lot#� �
<br /> Sub Division Parcel#
<br /> t-:.�..�...�.��r;.`:s::Cm .,.�:r:�.=t�.�o.v..��.,..�`:-r.`='..,.-:u:�^�=�F"�`C:".'_=:r'..e.:yr..,..,_.s:�Te-"`'....---r�..w_,..;�:i:'�?.,-�9.`<::G-:;.+.�x.......:....:m.- -_'"r�.�a.....v"`.'-�:-.,-::-y-:t.'w"'.:'°?>:"�-..';��`:s.�£ ._
<br /> ���_°'��y.-°�":r'�_
<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Haiardous 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 /> � emi �n er
<br /> Sprinkler � ❑ ❑ ❑ � � Recreafional Bum � ��
<br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers /��
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Flammable Application-ANNUAL ''7 �'� � Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
<br /> ._:�_;:,,.:..,,... ._.a.,,....�.. -„�„---.._R-.-.�,.-_x,�.W.�->..�.�...� � ,_..s-:e:,��. .�..�._��i��::. � .,.,,,�,��- �� �°..^.-:�..�-.::� ~��_�*.-�-
<br /> r.�«_..�.s.:n�.,.aa,�°r�...:��.....:,� �...,s,..,.,� . �n-r<,�,.».---°-�--., �,,��-�-.� ;�..�
<br /> •.-a..-��»..--. . a�,....n,�-._....�.• ,_�,'T'.,., . .. � �..,,...
<br /> .. :;;....� . _ � .._.�
<br /> ConVactor ,� " Company . .� � ,�7 t,T/ „�
<br /> Signature � Registered Y/N Fee CuRent 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#
<br /> ,.M, _ .,..:,.__.,. _ .. . .._ . -
<br /> ,:>•=.r••.�.:,>>:_w:_:r.��....�->;-�,.�� -- - .._�_ , ,-.�..�.....s ��_. .��� ,.. � .. .,� u�::�. - - - - x
<br /> . .. . _.
<br /> Directions: ...�...,_.,.,Yt..,_,�.._._�__,-•::_ . �... .._ . ..x_ _.. ._�---_�.. __,� �.�.._ �..�_..�,.,.----.�.,_ .�..__�-y,,:�,..._e�.__�..._-....�_ _._.m.
<br /> Fill out application completely.
<br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signed conVact with owner)
<br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000)
<br /> Supply two(2)sets of drawings with appticable documentation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) �
<br /> I
<br /> �I
<br />
|