� 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021
<br /> Permit Application
<br /> Date Received 3 P � Phone Contact for Permit T�_���_�
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<br /> Owners Name �/�'� � (,!%� �l� � �++ners Phone Number r_� � �
<br /> Owner's Address �p �33 - ��(,C� L�
<br /> Fee Simple Titleholder Name Titleholder Phone Number � O �
<br /> Fee Simple Titleholder Address '
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<br /> Job Address 3 g 33� �(,QJ ��- s ��7 ��'�.6.,(--� L� v Lot# '-- �
<br /> Sub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-ANNUAL W� Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL
<br /> � � Controlled Bum � Hood Installation _�
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � L atural Gas-ANIdUAL Sale
<br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL
<br /> 0
<br /> �y emi �n er
<br /> �
<br /> Sprinkler � ❑ ❑ ❑ � � Recreational Bum
<br /> Fire Alarm_ � ❑ ❑ ❑ � � Sparklers
<br /> Hood Cleaning � ❑ , ❑ ❑ � � Sprinkler System Installations
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys)
<br /> � Fire Alarm Installation � Torch RoofinglTar Kettle �
<br /> � � Waste Tire Storage ANNUAL /� ,
<br /> Fire Pumps
<br /> v
<br /> � Flammable Application-ANtdUAL Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
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<br /> Contractor Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Signature Registered l�/nl Fee Current Y/N
<br /> Address License#
<br /> PLUMBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MECHANICAL Company
<br /> Signature • Registered l�/1� Fee Current Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
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<br /> Directions:
<br /> Fill out application completely.
<br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required(AAechanical work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(httpJ/appraiser.pascogov.com)
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