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813 -780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021
<br /> Permit Application
<br /> Date Received I v'l / 09 I Phone Contact for Permit j I I
<br /> Owner's Name �C nth .;Q V 3 77 i7S L/
<br /> Owner's Address 57 .5 7 64/l /g /vrt/. 2ep4, - 4 //1 f/. 3.5 -1 //
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
<br /> Job Address S /S 7 64/1 ?/yc < 2' A r j,, / f/, 33r�// Lot#
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> 7 Controlled Bum I ( Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation --
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale ` j ' 3
<br /> n Fire Protection Maintenance - ANNUAL Places of Assembly - ANNUAL y (r �
<br /> lOtrry1 !Semi' Other �
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 1 Sparklers ,r 7C #' 1 ' ° Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations iil /
<br /> Hood Suppression CI ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> I I Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> I I Fuel Tanks
<br /> n Other: I I
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<br /> .,.�... ..�,.. .�., ,.,.,,. ,.,.a�....,. ......,u... ..W .. a nmtx, ..... �_,.�.. _. ...sue. ........�
<br /> Contractor e' 'J�
<br /> _ /j Company � ,/ I
<br /> Signature �2-,�� ./.7.--. ,C' Registered Y / N I Fee Current I Y / N
<br /> Address I License # ( I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N j
<br /> Address I I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N . 1 Fee Current I Y/ N I
<br /> Address ( ( License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # ( I
<br /> OTHER Company I
<br /> Signature Registered Y/ N J Fee Current I Y/ N j
<br /> Address J I License # I I
<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 (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 (http: / /appraiser.pascogov.com)
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