Laserfiche WebLink
813-780-0020 City of.ZephyrhillsFire. Fax - 813-780 -0021 <br /> Permit Application <br /> Date Received .Phone Contact for Permit <br /> A wner's Name CW 7 rt. AO i�Ltnih/pt. Atcf, rg per's Phone Number 83.6i. &d7 1757;a <br /> d Owner's Address 5FooerctiApte.grd C.d . t'1Gi (SC(cilnc`) R 3 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> /� '^",aR ` � _ /U „.. ` .^.a" .a.,•, x.Y / :. <br /> 0 , Job Address 7�7 J/ I V � • pJ v r u11 S / • Lot # <br /> Sub Division Parcel # <br /> 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 /> n Controlled Bum n Hood Installation <br /> 1 - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IL/My' !Semi FiTi Utner <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I 1 1 1 Sparklers <br /> Hood Cleaning V ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I n Standpipes (Sprinkler Sys) <br /> 1 Fire Alarm Installation n Torch Roofing/Tar Kettle , <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> n F el Tanks <br /> [T ether: ar . <br /> I �.. ..7 .. , . , �. , �. . .�. Contractor A 'aim- Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address 1 I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I License # <br /> PLUMBER Company <br /> Signature Registered Y // N Fee Current I Y / N <br /> Address I I License # l <br /> MECHANICAL Company <br /> Signature Registered Y/ N Fee Current I Y / N I <br /> Address I I • License # <br /> OTHER , Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <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). <br />