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s�3aso-oa2o Gity of Zephyrhills Fire Fax-813-780-0021
<br /> �,,,� ;, Permit Application
<br /> Date Received ..�ja� 7 � Phone Contactfor Permit �� ��.�++� 2 /
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<br /> Owners Name ��vu1✓�l i � �tt 7�� Uwne�s Phone Number .�O Z{ � '�'t� �{3��i
<br /> Qwne�sAddress ��'� 'f'�Y�"�� -
<br /> Fee Simpte Titleholder Name TiUeholder Phone Number � � �
<br /> Fee Simple 7ifleholder Address '
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<br /> Job Address S�R'S�"I ,� � 3� �A,t� �j t � Z� t� t"t1 r �t S �G 3 �,j� �.- Lot# �
<br /> Sub Dtvision Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Camm Exfiaust Kitchen Hood/Duct � Hazardous Material(Tier ti or RQ Faciiity)ANNUAL
<br /> „ � ControAed 8um � Hood lnstallation _
<br /> � Emergency Generator<30 kw � L.P/Natural Gas-installation
<br /> � Emergency�enerator>34 kw � l.PMatural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembfy-ANNUAL
<br /> ❑� emi � ' er ❑
<br /> Sprin&Ier O O O Recreatianal Bum
<br /> Flre Alarm � ❑ O O � � Sparklers
<br /> Hood Cleaning � ❑ , ❑ ❑ � � Sprinkler System tnstallations
<br /> Hood Suppression � D !� C! C� � Standpipes{Sprinkler Sys) .
<br /> � Fire Alarm Installatian Q Torch RoofingtTar Kettte '
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> � Flammable Application-ANNUAL � � Valuation of Praject
<br /> � Fuet ianks
<br /> Q Other: �
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<br /> Contractor �� �e Company
<br /> Signature �^"� �'"�"r� Registered Y/N Fee Current Y/N
<br /> Address l.icense#
<br /> ELECTRIClAN Company �
<br /> Signature Regisfered �Y/�1I Fee Current Y 1 N
<br /> Address L.icense#
<br /> PLUMBER - Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MEGHANtGAL Company
<br /> Signature • Registered Y I N Fee Current Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee CuRent Y/N
<br /> Address Licensa#
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<br /> D�G6GtIQ!"IS:
<br /> Fill out application completely.
<br /> Owner 8 Contractor sign back of application,notarized{Or,copy of signed cantract with owner)
<br /> lf over$2500,a Notice of Camme�cement is required{Mechanical work over$50�d)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> A!!ow 1 Q-94 days for review after submitta{date. Parce!#-obtained from Property Tax Notice(httpJ/appraiser.pascogov.com)
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