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813-780 -0020 City of Zephyrhills Fire Fax - 813-780 -0021
<br /> Permit Application
<br /> Date Received - Phone Contact for Permit
<br /> Owner's Name ,4 S / Owner's Phone Number
<br /> Owner's Address 3 a �' -C 5 (+-42 Z Q /J h y r' %/ ! //, /L• 4 Z
<br /> Fee Simple Titleholder Name [ Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address qJ jJ�A /'-' -< Lot#
<br /> Sub Division Parcel #
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<br /> Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> I I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> IK Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> (Utrlyl (Semil Fr71 Other
<br /> Sprinkler n ❑ ❑ ❑ Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers
<br /> Hood Cleaning ❑ ❑ ❑ I I I I Sprinkler System Installations
<br /> Hood Suppression Z ❑ X ❑ I I ( 1 Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation n Torch Roofing/Tar Kettle ,
<br /> n Fire Pumps n] Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I ) Valuation of Project
<br /> I Fuel Tanks
<br /> n O e r: I
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<br /> Contractor 1 I Company Ht� /9..4»! �! /I.G� t�¢�< 1
<br /> Signature //V (� Registered Y / 1 Fee Current I Y / N I •
<br /> Address I to;(SZ2 4- J74 A/. L.47-Leo ic=[ . ( License# ( g596s00003 i9gc
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I I License*
<br /> PLUMBER Company
<br /> Signature Registered Y / N I Fee Current I Y / N j
<br /> Address I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I License It
<br /> OTHER Company
<br /> Signature Registered Y /N I Fee Current I Y / N
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<br /> Address 1 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 (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 It - obtained from Property Tax Notice (http: / /appraiser.pascogov.com).
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