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a��-xso-oo2o City of Zephyrhills Fire Fa�c-813-780-0021
<br /> . � Permit Application
<br /> Date Received '�"��- 'Z u 1� Phone Cantact for Permit (� {�j 3 ��' jp��
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<br /> Owners Name ix,��,} �G�'�-� L,pPJb �`,, Owrse�s Phone Number � � C�
<br /> Owne�s Address �{$ s �iJ �y}�,D �,L
<br /> Fee Simple Titleholder Name Tilleholder Phone Number � � .L�
<br /> Fee Simpie Titteholder Address '
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<br /> ,►ob Address.� �$`j Z Z. f� ,�eV����lf" �-jr�ll '�J % ., � Lot# ��
<br /> Sub Division Parcet# / '/�ti•.��•041 iD'b('7G0'l30lo O
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<br /> 1�
<br /> � Sio-Hazard Waste Storage-ANNUAL � Fumigatlon Tent
<br /> � Comm Exfiaust Kitchen HoodlDuct � Wazardous Material{Tier il or RQ Facility}ANNUAL
<br /> � Gontrofled Bum � Hood Installation _-
<br /> � Emergency Cenerator<30 kw LP/Natural Gas-instaifation
<br /> � Emergency�enerator>30 kw � �P/Natural Gas-ANtdUAL Sele
<br /> � Fire Protection Maintenance-ANNUAL � Piaces of Assembly-ANNUAL
<br /> � em �n er
<br /> Sprinkler � ❑ ❑ L7 � � Recreationat Bum
<br /> Fire Alarm � O Cl ❑ � � Sparklers
<br /> Hoad Cleaning � CI , C} � � � Sprinkler System)nstaltatians
<br /> Haod Suppressian � � � D � � 5tandpipes(Sprinkler Sys) ,
<br /> � Fire Alarm Installation � � Torch RoofingtTar Kettle '
<br /> � Fire Pumps � Waste Tire Storage ANNUAL ,
<br /> � F�ammable Application-ANNUAL 60b•b e Valuation of Project
<br /> � Fue!Tanks
<br /> Q Other:
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<br /> Contractar . Campsny '
<br /> Signature Registered Y/N Fee C nt Y/N
<br /> Address i.icense#
<br /> ELECTRIGIAN Gompany
<br /> Signature tze9�sterea -Y 1 N Fee Current Y 1 N
<br /> Address License#
<br /> PLUMBER Company '
<br /> Signature Registered Y/N Fee Current l�/N
<br /> Address �icense#
<br /> MEGHANtGAI Gompany
<br /> Signature • Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signatura Registered Y/N Fee CuRent Y!N
<br /> Address License#
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<br /> L}tiBClIQ!'IS:
<br /> Fill out application completely.
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> It over$250d,a tlatice ot Gommencement is required(Mechanical work aver$5444}
<br /> Supply twa(2)sets of drawings with applicable documentatian
<br /> Allow 10-94 days for review after submittal date. Parcef#-obtained from Property Tax Notice(http://appraiser.pascogov.com)
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