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a�sa8o-ao2a City of Zephyrhills Fire Fax-813-780-0023
<br /> Permit Application
<br /> Date Received ' � ��� �—J i Phone Confact.for Perm'it� j '' %���
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<br /> Qwne�s Name s Owner's Phone Number
<br /> Owner's Address `
<br /> Fee Simple 7itleholder Name Titleholder Phone Number � � ��
<br /> Fee Simple Titteholder Address `
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<br /> Job Address � Cy'"/`f L` !.� Lot# z �
<br /> Sub Division Parcel# �"�� 2�'-v[/'�"'U.�/p'
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent �
<br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous{Naterial(Tier II ar R{1 Facility}ANNUAL
<br /> „ � Controlled Bum o Haod Installation _
<br /> � Emergency Generator<30 kw Q LP/Naturai Gas-tnstaliation ti � , i
<br /> C.� 9 Y 0 ��„ ��� j"�,.�,
<br /> Emer enc Generator>30 kw l.P/Natural Gas-ANI�UAL 8ale
<br /> � Fire Proteotion Maintenance-ANRtUAL Q Piaces of Assemb(y ANNUAL
<br /> Ifr y em � er
<br /> Sprinkler � C] I� C} � Recreafional Bum
<br /> Fire Alarm � ❑ Cl ❑ � �5pa��~��
<br /> Nood Cleaning � Cf , � ❑ �.�� Sprinkler System MstaHatians W jUl r�+r I"f 2� G/ ��
<br /> Hoad Suppression � ❑ ❑ ❑ ---��Siandpipes{S�r�nklerSYsj ��— �-
<br /> �;�����--
<br /> � Fire Alarm installation Q 7oroh Roofingtfar Kettie � � ?. �rl -
<br /> � Fire Pumps o Waste Tire Storage ANNUAL �� ^7,�'���wv�+—,
<br /> � Fiammabie Appiication-ANIdUAL T
<br /> r�(vpt�r t� Va uation of Praject
<br /> � Fuei Tanks � ��C'"
<br /> Q dther: i
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<br /> Contraetor (-�� Company '"� f�lfj} ! /`�dj '"� .+G.3
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address `� � � � / �j4� � , ttll� !l�Nd J�3G�'license# � . l� j�il��
<br /> ELECTRICIAN ` �!""Gompany
<br /> Signature Registered -Y/RI Fee Currenf Y/1�1 .
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address �icense#
<br /> tNEGFiANiGAL Company
<br /> Signature • Registered Y/N Fee Current Y I N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
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<br /> pirectiarrs: vr..r..a .�..��ti.,�.�.___._�..�:��
<br /> Fill out application completely.
<br /> Owner&Contractor sign back of application,notarized(Or,capy of signed contract with owner)
<br /> If over$2600,a Nof'sce of Commencement is required{Mechanical work over$5044}
<br /> 8upply twa(2)sats of drawings with applicable documentation .,.. ,.
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Ta�c Notice(http://appraiser.pascogov.com)
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