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�. 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
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<br /> � � Permit Application
<br /> date Received —� Phone Contact for Permit ��'� � ��3 ����
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<br /> 'Owner's uame �.�...... . �G '�s�`'���'"t1-}1 qt�'t _.. _..�,�,. � -�_. Owner's Phone Numbar ��Fl �O� �J��
<br /> Qwner'sAddress `t� �YQ�SSfo11lA` t„�¢r'1�i' � �� `t� (�1VY1 ��[, U.�'�2.4'1S 1!L �.���'�� J"f �• �i(JJ
<br /> Fee Simple Titleholder Name Titleholder Phone Number �� � �
<br /> Fee Simpie Ti#Ieholder Address ,_ _
<br /> ldob Address,_ ,....., .��J � �'tGC-�1 27 t�C� �� � 'I'� 1 i t� � a �i��Z ��ot# ._, �w.��
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � f��!�,�
<br /> � Camm Exhaust iCitchen Hoodtduct � Hazardous WEaferial'{Tier il or RQ Facility)ANNUAL
<br /> � Controlled Bum � Hood Installation -
<br /> Emergency Generator<30 kw � GPIPIatural Gas-lnstallation � � � ,1
<br /> � Emergency Generator>3Q kw � LP/Natural Gas-ANNUAL Sale �U ��(��, �GC�G��l� � �U
<br /> � � !
<br /> Fire Proteetion Maintenance-ANNUAL � Places of Assembly-ANNUAL
<br /> - ry emi � t er ' ���--���
<br /> Sprinkier � ❑ Ci ❑ � � Recreaiionai Butr� ����Q� '
<br /> Fire Alarm � ❑ ❑ ❑ � ❑ Sparklers
<br /> Nood Cleaning � ❑ ❑ O C� � Sprinkier System InstaiEations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler 5ys)
<br /> � Fire Alarm Installation � Torch Roo5nglTar Kettie
<br /> � Fire Pumps Waste Tire Storage ANNUAL
<br /> � Flammable Appiication-ANNUA� Vaivation of Praject
<br /> � Fuel Tanks
<br /> QOther: _ , _ , . .... ,
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<br /> Gantractor Gampany
<br /> Signature Registered Y J N Fee Current Y/N
<br /> Address license#
<br /> ELECTRICIAN Company
<br /> Signature � RegisYered Y!N Fee Current Y!N
<br /> Address License#
<br /> PLUMBER Gompany
<br /> Signature
<br /> Registered Y/N Fee Current Y/N
<br /> Address License# _
<br /> MECHANICAL Company
<br /> Signature
<br /> Registered Y 1 N Fee Gurrent Y 1(�l
<br /> Address License#
<br /> OTHEF2 Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> - - , �..,�.W. ., �.: :�w'� �.:..
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<br /> Directions:
<br /> FiII out application campletely
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner}
<br /> !f over$250Q a Notice of Commencement is required(Mechanical work over$5000)
<br /> Suppty two{2}sets af drawings with applicable documentatian
<br /> Allow 1 p-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogav.com)
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