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<br /> s�s-7so-oo2o City of Zephyrhills Fire -�����F��-'�8 -
<br /> Permit Application
<br /> Date Received Phone Contact for Permit � M� ,j�j[� I
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<br /> Owner's Name � Owner's Phone Number I 7 �j �3
<br /> Owner's Address' Z�jj �,� � , �����/� . �j�7.��� I
<br /> Fee Simple Titleh Ilder Name Titleholder Phone Number � � �l
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<br /> Fee Simple Titleh�Ider Address
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<br /> Job Address ZU � �V�l � � �J,�,')T�� 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 8um n
<br /> � Hood Installation �
<br /> �� Emergency Generator<30 kw � LP/Natural Gas-Installation /� ,���
<br /> � �
<br /> �� Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale \y �-Z`
<br /> �� Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL �,•.: �
<br /> ry emi �n er �..���C��.!
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum � 1� �`-
<br /> � �t �
<br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers � ;� ,�
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations , � �
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) ���� -
<br /> � Fire Alarm Installation � Torch Roofinglfar Kettle �Q.
<br /> � Fire Pumps � Waste Tire Storage ANNUAL �
<br /> �I Flammable Application-ANNUAL Valuation of Project
<br /> � Fuel Tanks
<br /> ;I Other:
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<br /> �ontractor I � Company � , i
<br /> Signature �Q Registered Y N Fee Current Y/N
<br /> Ad res �};S License# '.�
<br /> ELECTRICIAN � ompany � 1G ���
<br /> Signature � � • Registered �Y�Y N Fee Current Y/N
<br /> Address �fJ� — License# �C1D�
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<br /> PLUMBER � Company �p, ,j,�i,� �rp� �
<br /> Signature � Registered p�/N Fee Current Y/N
<br /> Address ' �Q . ____.�_ 6icense-#.--_�—_
<br /> —_�---- ' �_
<br /> MEC CAL 9 --"`�— Company ��• r— , �
<br /> nature ,�� � Registered Y%N Fe Current Y/
<br /> Address �, License# r 7
<br /> ��
<br /> OTHER I omQanY ��f
<br /> Signature I Registered I Y�N I Fee Current Y/N
<br />� Address i,� License#
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<br /> Directions: �
<br /> Fill lout application completely
<br />� Ow{�er&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> If o�Yer$2500,a Notice of Commencement is required(Mechanical work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> All w 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http:f/appraiser.pascogov.com)
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