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813 - 780 -0020 City of Zephyrhills Fire „,:r rq - iJ - 2 , Fax- 813- 780 -0021
<br /> Permit Application l/
<br /> Date Received, I
<br /> • ! Phone Contact for Permit
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<br /> Owner's Name I Pankaj Patel Owner's Phone Number I I 1 1 1 I
<br /> Owners Address 29341 Rhodin Place, Wesley Chapel, FL 33545
<br /> Fee Simple Titleholder Name I Titleholder Phone Number I I I
<br /> Fee Simple Titleholder Address I I
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<br /> Job Address 6815 Gall Blvd, Hiway 301 North, Zephyrhills, FL 33541 Lot #
<br /> Sub Division ( I I
<br /> Parcel #
<br /> .: . . _... WM.U, ''..'' ' ' ,, ,. 1u,,: � ., AgAMIKVe IV .,., WW¢ IIMMINMV'''
<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> a Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Burn n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> pm (Semi LW Other
<br /> Sprinkler El Jfif ❑ ❑ n Recreational Burn
<br /> Fire Alarm D ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning D ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression El ❑ ❑ ❑ I ( n Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> E Fire Works
<br /> n Flammable Application- ANNUAL I I Valuation of Project
<br /> Fuel Tanks
<br /> 0 Other: I
<br /> 3mt >,€sE»..;, ,,,,, w e „e> . -MaiM,,. ,,MmAkefio > &, . ,,. r� , e
<br /> . o :SUM aw..ae Y d UMPA W9 ...a )1 « iMP
<br /> Contractor Company YSC -fs 5 4 ^ / A I
<br /> Signature Registered Y/ N I Fee Current I Y/ N f
<br /> Address
<br /> I License # I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N . 1 Fee Current I Y/ N I
<br /> Address I
<br /> I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I
<br /> I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current 1 Y/ N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I
<br /> Address
<br /> License #
<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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