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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received 1 I. Phone Contact for Permit
<br /> I 1 I 1
<br /> Owners Name St Joseph's Catholic Church Owner's Phone Number 1 813 1 782 1 2 813
<br /> Owner's Address 5316 llth St Zephyrhills F1
<br /> Fee Simple Titleholder Name Same Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
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<br /> church bldgs corner 5th ave - llthst 16th st
<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> :: <!.. x3 ? ± i44 4- A.RAt,'rvi ,. ....q. va , I7i* , aS.:.sit .. .'014Cir.: ;ItttN. `UV : `? fl F:' ?343. `. 3 " "x3'44,14 r. :7 5:: ' nVrid ,14a :'1yw.@:Px. Y-CP .. d,i f "e a .,ra. ; u.$..m,,, .,. „:v .s?l'
<br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> II Comm Exhaust Kitchen Hood /Duct = Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> I - 1 Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> r y 'Semi' Lai Other
<br /> Sprinkler D ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm 71 ❑ ❑ X5 1 1 n Sparklers
<br /> Hood Cleaning = ❑ ❑ ❑ 1 1 n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> Fire Pumps n Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL I $ 2 9 5. 0 0 I Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I
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<br /> contractor Company Russell Electrical Const 1
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I 41220 thomas boat landing Umital la I Fl License# I EF 0002542 (
<br /> ELECTRICIAN Company
<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 1 Y/ N I
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I
<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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