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e F�3-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Agplicatian
<br /> Date Received �w � Phone Contact far Permit ��M�� ��� �
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<br /> Owner's Name R�.'�� h� � c n d1 �(1 S "�'Op Owner's Phone Number t� �� C�_�
<br /> Owner's Address , � f h �/�. i
<br /> Fee Simpie Tfitieholder Name �� �� Titleholder Phone Number �� C� !
<br /> Fee Simpie Titleholder Address �
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<br /> ' Job Address Lat# �___� �
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<br /> Sub Divisian Parcel# , �
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<br /> � Bio-Hazacd Waste Starage-ANNUAL � Fumigation ient ,
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material �' �
<br /> � Controlled Rum � Haad lnstal(ation �
<br /> • Q Emergency Generator<30 kw � LP/Natural Gas-Installation �
<br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
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<br /> � Fire Protectian Maintenance-ANNIlAL �Piaces af Rssembiy-ANNIlAL '
<br /> Sprinkier � � Recreational Bum �,
<br /> Fire Aiarm � � Sparklers f��j C� �
<br /> ��l (J ,
<br /> - Hood Clean/8uppression � � Sprinkler System Installations �
<br /> � Fire Alarm Installation � Standpipes(Sprinkler Sys) ,
<br /> � Fire Pumps � Torch Roofing �
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<br /> � Fire Works � Waste Tire Storage �
<br />� � Flammable Appl'scation-AhliVUAL
<br /> oFuel Tanks
<br /> Q other:
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<br />' Contrac#or Company (
<br /> Signature Registered Y/ N Fee Current Y/N
<br />� Address _License# �
<br /> ELECTRICIAN Company �
<br /> Signature � Registered Y/N Fee Current Y/N �
<br /> Address Licerrse# �
<br /> PLUMBER Campany i
<br /> Signatt�re Registered Y I N Fee Current Y/N
<br /> Address License#
<br /> MECHANICA� Campany ;
<br /> Signature Registered Y/N Fee Current Y/N !,
<br /> Address License# ;
<br />, 4TFiHFt Company �
<br /> Signature Registered Y/N Fee Current Y I N
<br /> Address License#
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<br />, Directions:
<br /> Fill out application campletely.
<br />' Owner&Gonb'actor sign back of applicafion,notarized(4r,copy of signed contract with ovmer}
<br /> If over$2500,a Notice of Commencement is required(Meahanical work.over$5000)
<br /> � Supply two(2)sets of drawings with applicable documentation
<br /> � � , Aliow 10-14 days for review after submittal date., .
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