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813-780 -0020 City of Zephyrhills'Fire q qZ Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received O-" �'7 Phone Contact for Permit
<br /> I
<br /> Owners Name K% t,,' / V K.I11 ,+ Owner's Phone Number X ( 2, ?R2. 11.S7
<br /> Owner's Address
<br /> 76A i 6 .81 uc( 2 iyiLk 1$ SI- 3.1510
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
<br /> ., ,.. M: ?,..ea0Z .e at'A .:::: -r7, 46 , , ? to ttMWt ..0 7... `Er", a""l ,.Es Z1t G, .. , , .,ate1 .,<. . , € = e
<br /> Job Address - 763 i 6a4i Ott P i((5 b " L 333gc, Lot#
<br /> 1
<br /> Sub Division Parcel #
<br /> ,....,;,. wg,7,,t 6 3 .,s,z - 1 .,, ,-,, ,, r,.w,ifo w-imiwagi. vgie ...;r:07,g.. '.k ..d? .,x' aes,a` .df ',a .. .,. ,woe r` .......,. ,, .,. _ ..
<br /> n 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 /> El Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation /21? / n Emergency Generator> 30 kw n / LP /Natural Gas - ANNUAL Sale / ^ /c?'j' n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL V V
<br /> )Utny1 I Semi I l Uther
<br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum
<br /> Fire Alarm 0 ❑ ❑ ❑ I I I I Sparklers
<br /> N od Cleaning El Ja ❑ ❑ I I I Sprinkler System Installations
<br /> H ood Suppression n ❑ ❑ ❑ I f 1 Standpipes (Sprinkler Sys)
<br /> FT Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> Fire Pumps I I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I I Valuation of Project
<br /> Fuel Tanks
<br /> FT Other: I
<br /> Contractor Company Foci //lee_ I
<br /> Signature v � i/AIR Registered Y / N I Fee Current I Y / N I
<br /> Address I License #
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N 1 Fee Current Y/ N I
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y / N 1
<br /> Address I I License #
<br /> OTHER Company
<br /> Signature Registered Y/ N j Fee Current Y/ N 1
<br /> Address
<br /> l ° License #
<br /> I v
<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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