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' 913- 780 -(J20 City of Zephyrhills Fire > Fax -813- 780-0021
<br /> Permit Application _
<br /> Date Received JV ' i 9-` - .2c' 7 1 Phone Contact for Permit FEW Lt 75 �C
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<br /> Owner's Name Owner's Phone Number I _
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
<br /> Job Address cii, A , j I2r 4 (%r, 11 7 , 'i3 f` , 5 -- ` 13 t 70A r_ 3 35 I Lot #
<br /> Sub Division Parcel #
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<br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> I I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> FT Controlled Bum n Hood Installation
<br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> I 1 Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> FT Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> ILttny) (semi Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm El ❑ ❑ ❑ I n Sparklers
<br /> Hood Cleaning ❑ ❑ ❑ I 1 n Sprinkler System Installations
<br /> Hood Suppression I idi ❑ ? . ❑ I l I I Standpipes (Sprinkler Sys)
<br /> I Fire Alarm Installation ![ n Torch Roofing/Tar Kettle
<br /> (n Fire Pumps n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> n Flammable Application- ANNUAL 1 1 Valuation of Project
<br /> n Fuel Tanks
<br /> Q Other: I
<br /> .eta =:25, 'Sl lZ ..e „k= ..x s.- .s..4z�s”' u, n �. .':i4F 0-i?' a -y?S8C:S drr v.A.',,.3%`tc x F.ab »:;'se:., ,, +u«r- rzM. w'_X "L'h3 "ki:..Y' :k' 5.., n_f �:..X, _.u.. dJi <:4:.a „a _ ..s ss<<. vd eix: =.Xr .pYn'a^sY .,� . „dw:r. ,'0. ✓..,a0-.�§t?'
<br /> Contractor �1 Company M - p h3 - P' r j kY)-� fj tr' I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address 1 -/70! oG i-c. F4r r- i5 Lire-" - re.. - 41 1 License # 71, C ,.-00(, I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N . I Fee Current I Y/ N I
<br /> Address ( I License # I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address License #
<br /> R.
<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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