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s�aaso-oo2o City of Zephyrhills Fire � Fax-s�s-�ao-oo2�
<br /> Permit Application
<br /> ate Received Phon Co erm ��?j �� � ��Z-
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<br /> �wners Name 1"l�i c�-►�,7•i -7� �-t'�J� �-�-C Owner's Phone Number � � �
<br /> �wner's Address 1`�� I v''1'-'�b� (�l/'t'1`-t� � L�Uri "''� �C� '�'�"� ��"t-` �2�' .
<br /> ee Simple Titleholder Name Titleholder Phone iVumber � � �
<br /> ee Simple Titleholder Address '
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<br /> �b Address� j�'�� l �!-�LL �j LU��x- �P 1�u�'�+�t)l�-> v—l Lot# �
<br /> ub Division Parcel#
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<br /> � Bio-Hazard Waste Storage-AfdNUAL ,� Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facitity)ANNUAL
<br /> „ � Controlled Bum � Hood Installation _�
<br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation
<br /> � Emergency Generator>30 kw � LP/Natural Gas-AF11dUAL Sale
<br /> � Fire Protection Maintenance-ANtdU.4L � Places of Assembly-ANNUAL
<br /> � emi � er
<br /> Sprinkler � ❑ ❑ ❑ , � Recreational Bum
<br /> � ��5
<br /> Fire Alarm � ❑ ❑ ❑ � � Spark�ers % r}� a1_ �
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<br /> Hood Cleaning � ❑ , ❑ ❑ � � Sprinkler System Installations � -n
<br /> �7�tfr
<br />, Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) v �
<br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle ' ����Y�
<br /> � Fire Pumps � Waste Tire Storage ANNUAL ,
<br /> � Flammable Application-AIdR1UAL 3 2 �-' Valuation of Project
<br /> � Fuel Tanks
<br /> Q Other:
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<br /> :ontractor . Company
<br /> �ignature Registered Y/(� Fee Current Y/N
<br /> Address License#
<br /> :LECTRICIAM Company
<br /> �ignature Registered �Y/iV Fee Current Y/N
<br /> Address License#
<br /> 'LUMBER Company '
<br /> �ignature Registered Y/IV Fee Current Y/IV
<br /> Address License#
<br /> AECHANICAL Company
<br /> >ignature • Registered Y/f�l Fee Current Y/N
<br /> Address License#
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<br /> l// J�nl� /U. 7��P2�
<br /> iignature (, � � Registered /IV Fee Current N
<br /> Addr s t O ( �'l U�2D� �2l1/� ' L(�7Z FL-- �3.5�� License# 'Z2�1l$^O�[Zo� � _
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<br /> )irections: -_--���-•___..,-,.___.
<br /> Fill out application completely.
<br /> Owner 8 Contractor sign back of application,notarized(Or,copy of signed contract with owner)
<br /> If over$2500,a Notice of Commencement is required(Mechanical 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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