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, - 813-780 -0020 City of Zephyrhills Fire ._14 616 q- Fax - 813 -780 -0021
<br /> Permit Application '
<br /> Date Received I ID-27 —O Phone Contact ntact for Permit ri Owner's Name 1i itil eu2 7 Owner's Phone Number , (3 71.3 ,I g
<br /> Owner's Address 7M 22 Cc...-1( JM')cl k F/ - `35 y / l
<br /> Fee Simple Titleholder Name `1` Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address 7q Z (pall QI U 2-cp ye_ _(46 F - 36'k 1 Lot#
<br /> Sub Division Parcel #
<br /> .A.:.' 4 .. , .. IP.O.INS1 :A 3...Y MT.;,.0 ea4. 0FAIM, , € ,44 eatra,".> " ' s..4s .. ss3 .> ae* w.A IUTONRKE- W. W. WKE. Z, r .._.- z,? 't v i M.,.M s": ...,za ANZIA -4
<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> n Controlled Bum [ I Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> lUtrly1 Semi) OA other tG' 111 Sprinkler ❑ El 12 n Recreational Bum 4/0C?
<br /> O
<br /> / Fire Alarm El ❑ ❑ ❑ I n Sparklers
<br /> \/H Cleaning 0 X El ID n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I n Standpipes (Sprinkler Sys)
<br /> I - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> n Flammable Application- ANNUAL I I Valuation of Project
<br /> n Fuel Tanks
<br /> n ther: I
<br /> ..._..:;�..... F....a ::mEw .; r. r •;" a�0•vxs�kr§ctet.:: arm, E .. .< WN ....M._.h1iMf ��'"< sx. ar.,, k' �.ai.saiZaEWAINZEia ��:,"SZP,M'w.' M'MEINE ..,
<br /> Contractor Company Foci rl ree, I
<br /> Signature /l , �. V Registered Y / N I Fee Current I Y / N I
<br /> Address " 1 License # ( (
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N I Fee Current I Y / N 1
<br /> Address I I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N Fee Current 1 Y/ N 1
<br /> Address I I License # I I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N ] Fee Current I Y / N
<br /> Address I I License # I I
<br /> OTHER Company I
<br /> Signature Registered Y / N ] Fee Current I Y / N
<br /> Address License #�I
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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 # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)
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