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813 -780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received I / 5 N ( Phone Contact for Permit J
<br /> / Owner's Name n 7 k / e T 5 . 5 — e , Owner's Phone Number
<br /> / Owner's Address - lf .,2 (r �� 1 3 --y/
<br /> Fee Simple TitTehi . arm Titleholder Phone Number
<br /> Fee SimpIeJ ti fiolder Add I
<br /> /Job Address Lot #
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n In Controlled Bum Hood Installation - __
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n �. ,
<br /> Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale /
<br /> I7 I Fire Protection Maintenance - ANNUAL n /
<br /> Places of Assembly -ANNUA
<br /> Iutrlyl I Semi I Ma other ��' /// I O Sprinkler n ❑ ❑ ❑ I I Recreational Bum �/
<br /> Fire Alarm
<br /> ril ❑ ❑ % I I n Sparklers
<br /> Hood Cleaning ❑ ❑ ❑ I n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys)
<br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps 1 1 Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> 1 1 ,—I
<br /> Flammable Application- ANNUAL ` I Valuation of Project
<br /> I Fuel Tanks
<br /> I Other: I
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<br /> Contractor Company
<br /> Signature Registered Y / N J Fee Current I Y/ N J
<br /> Address I
<br /> 1 License # I tit
<br /> , �� ..rte•
<br /> r
<br /> ELECTRICIAN , /%3 Company 1A7.05, i�i �f��I E
<br /> Signature ee?" / �yr�� Registered Y / ', Fee Current Y / N
<br /> Address I ` I License # -1
<br /> PLUMBER Company
<br /> Signature Registered Y / N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N 1 Fee Current I Y / N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y / N I
<br /> Address I License # I
<br /> ....s
<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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