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aaa- sa-oo2a City of Zephyrhills Fre Fax 813-78Q-002'!
<br /> �, . Permit Application
<br /> Date Rec �— � Phone Cantacf far Permit ��j�� �n� �2-�-�
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<br /> er's ame - 4�� ���'1 �� ., f�"��1��� �-�"'� Owner's Phone t3umber s�'+� �p� 0�'�'t
<br /> er's Addressl O� �W V� � G✓C. fl YVl, �� � 'T'�-- 3� S �'1 ( �
<br /> Fee Simple Title older Name Titleholder Phone Number [_�_� � �
<br /> Fee Simpte Tittel older Address
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<br /> Job Address � 1 fJ� -} ��j�d�.—��. -� I �u�� ��Y 1'!Y 1�/��� � .�'�...�j.�'J�1l�r Lot# �
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<br /> Sub Division Parcel#
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<br /> �� Bio-Hazard Waste Storage-ANNUAL Q Fumigation Tent
<br /> Q Comm Eathaust lfitchen NaodlDuct o Hazardous Material{Tier 1!ar RQ Facility}ANNUAL �C�
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<br /> Q Controlled Bum Q Hood Installation `
<br /> � � Emergency Generator<30 kw o LPINatural�as-tnstallation � �
<br /> � �� Emergency Generator>30 kw /Nataral�Gas-ANNU�AL��Sale
<br /> Fire Protectian Maintenance-ANNUAL Piaces of Assem ly-ANNQAI [�
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<br /> Sprinkler � ❑ C� ❑ / ecreational Bum ��� ��
<br /> Fire Alarm � ❑ ❑ ❑ , � � Sparklers
<br /> Hoad Gleaning � ❑ ❑ ❑ � � Sgrinkler System tnstallations
<br /> Hood Suppression � ❑ ❑ ❑ C� � Standpipes(Sprinkler Sys)
<br /> QFire Alarm Insta{lation � Torch Raofing(Tar Kettie �
<br /> � Fire Pumps - Waste Tire Storage ANNUAL
<br /> � Flammable Appiicatian-APiNUAL �--� Valuation af Project
<br /> � Fuel Tanks
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<br /> ontractor Campany
<br /> Signature Registered Y/N Fee Current Y/N
<br /> ddress G License#
<br /> ELECTRICIAN Company
<br /> • Signature Registered Y/N Fee Gurrent Y!N
<br /> Address � License#
<br /> PLUMBER Company
<br /> 3ignature Registered Y/N Fee Current Y/N
<br /> Address ( �icense#
<br /> MECHANICAL I Company
<br /> Signature Registered Y 1 N Fee Gurrent Y(N
<br /> Address License#
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<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
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<br /> DIf8Ct1011S: +
<br /> FiII out applicatian compietely.
<br /> Owner&Contractor sign back of application,notarixed(Or,copy of signed contract with owner)
<br /> 1f over$2544,a Notice of Commencement is required{Mechanical work over$5040)
<br /> Suppty two(2}sets of drawings with appticable dooumentation
<br /> Allow 1 D-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.00m)
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