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813 -780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received Phone Contact for Cont or Permit
<br /> Owner's Name S-/ ./1' Sj, /7he��� ,/l1�.l "' Owner's Phone Number
<br /> Owner's Address 3 ? 2 3 % /. zA 7 /e - ?Yi - i ,
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
<br /> .. ;..,.x ZR,...., e «z tea,. . w tifda, . - , Mi g R I E.t'a'`",,,. .,, a .:`, ,., ,. T. 'f , ., ,,,, . ;3 ..: . . :. . ...... . ., ; z _, u, , .
<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> F 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 /> n Controlled Bum n Hood Installation
<br /> FT Emergency Generator < 30 kw n LP /Natural Gas - Installation , -
<br /> I I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale ,." 4 " -- -
<br /> 71 Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> Iutnyl ISemi) rATT 1 Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum ' I
<br /> Q b
<br /> Fire Alarm j( ID ID I 1 n Sparklers
<br /> Hood Cleaning n ID l=1 0 I 1 1 1 Sprinkler System Installations ,/
<br /> Hood Suppression ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) -- --
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> Flammable Application- ANNUAL ` ( Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I
<br /> s. 'e ...:;::E:m a _.,r., : 3:�,., r. ..,9.' x EI r :q ; 21iMfi'... ��aru n..SW.SCZ <.x�. i..:�<<�`..,. �.,��:M:E..a; r. u, «.. ..., l.,.. E i ,.., a.:' , ,..k ta.. ,.tEIW = :'J tig »"' :.�..._....�ra: :ZW:f :: I
<br /> Contractor Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> ELECTRICIAN Company
<br /> Signature l�.d.0/. fe ,, ' Registered MEM Fee Current Y / N
<br /> Address ! .4.,, ' - i J f '' ,„..i - License #
<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 I Fee Current 1 Y / N 1
<br /> Address I I License #
<br /> OTHER Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I License # j
<br /> Di rections: w .... _ .... sa.. __..x _, ....u. ....., c...
<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 55000)
<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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