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813-780-0020 City of Zephyrhills Fire Fax- 813 -780 -0021
<br /> i. Permit Application
<br /> Date Received I Phone Contact for Permit
<br /> %Owner's Name ( / 11-1- /41(106 CEfdiQCIr( or ZEf Q/{Iu -S Owner's Phone Number
<br /> XOwner's Address Coa , 5 — / r C/ fs'/A) RD -
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
<br /> rJ' Job Address 6 026 7 FD , eTW/,J & A. - Lot #
<br /> Sub Division Parcel #
<br /> . v: , , 4,,,.va mZ .= . „ M.62...a, t,«.,, ,;:, kw. , . :4,44uk' ` uIWaW , ':44, . xi,,, & .,Tom. .teati . s., .mss ° .1,1,M P ?._ -. ,..T f , ,.,� ......laU. . a ..,m
<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> 1 1 Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> I Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL M Places of Assembly- ANNUAL
<br /> IUtrly1 !bemil F a i l other
<br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I n Standpipes (Sprinkler Sys)
<br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> Fire Pumps n Waste Tire Storage ANNUAL
<br /> --- Fire Works
<br /> I Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
<br /> . .::m.,Mn,_..m4m - a,c. BIZSI. <.aeMO.ra`t',Marg4Ala..r3VetrA , • :1/M . A : CEOMIk.`ELI: 5>.,:aa,..°MEM- 's ,c.?..��..: xt.. 4 :Via, a.r. a, .�a LiMata..:a, ?i.... a�..,.k.:..' lFigKWAV,:2.
<br /> Contractor n Company I
<br /> Signature +� Ci* Registered Y / N j Fee Current I Y / N
<br /> Address I I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N . 1 Fee Current I Y / N
<br /> Address I I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I I License #
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address I
<br /> 1 License #
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I License # I
<br /> �`3 .iG�,`a;?k:i "sS .........�..:a.: ..„.,:;+� .. ..,. �.,..: .._.z..,�..�res;;s:n� „E�;rama. e:�.w- a.:.a,�s: acs..,. �:.. awi° atS "i ,. >. .. €.��,,' ,.,,W .,. '�i.
<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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