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81;1-780-002Q City of Zephyrhills'Fire. Fax - 813 -780 -0021
<br /> Permit Application
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<br /> Date Received Phone Contact for Permit
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<br /> Owner's Name , STMPT,FXGRTNNF,LL Owner's Phone Number 813 626 5482
<br /> Owners Address 4701 Oak Fair Blvd TAMPA FL 33610
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<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address ? 7 6 100 f U to►e. r LA . (41 h kit 5 VL 35-1- Lot #
<br /> Sub Division Parcel #
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<br /> J Bio- Hazard Waste Storage - ANNUAL Fumigation Tent
<br /> 1 Comm Exhaust Kitchen Hood /Duct Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> 1 Controlled Bum Hood Installation
<br /> 1 Emergency Generator < 30 kw LP /Natural Gas - Installation
<br /> 1 Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale
<br /> 1 Fire Protection Maintenance - ANNUAL Places of Assembly- ANNUAL
<br /> 1Utrlyl (Semr1 IAnl ( Other
<br /> Sprinkler 1 1 ❑ ❑ ❑ 1 I Recreational Burn
<br /> Fire Alarm N2r ❑ ❑I 1 1 I Sparklers
<br /> Hood Cleaning 1 1 ❑ ❑ ❑ 1 I I ( Sprinkler System Installations
<br /> Hood Suppression 1 1 ❑ ❑ ❑ 1 1 I Standpipes (Sprinkler Sys)
<br /> 1 Fire Alarm Installation 1 1 T Roofing/Tar Ro r Kettle
<br /> 1 Fire Pumps 1 I Waste Tire Storage ANNUAL
<br /> 1 Fire Works
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<br /> Flammable Application- ANNUAL I I Valuation of Project
<br /> 1 ' 1 Fuel Tanks
<br /> 1 Other: 1
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<br /> Contractor /
<br /> d Company -) Crot? KFrw -e. t (
<br /> Signature Registered Y/ N I Fee Current 1' Y / N 1
<br /> Address 1 License # - 1
<br /> ELECTRICIAN Company
<br /> Signature . . Registered Y/ N 1 Fee Current 1. Y / N 1
<br /> Address 1 1 License # 1 1 ,
<br /> PLUMBER - Company
<br /> Signature Registered ¥ / N* 1 Fee Current I Y/ N` 1
<br /> Address 1 1 License # . • I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N 1 Fee Current Y / N j
<br /> Address 1 1 License # 1 1
<br /> OTHER Company -
<br /> Signature Registered Y / N 1 Fee Current I Y / N1
<br /> Address License #
<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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