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813 -i €'5.0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received ii 0 7 1 Pho ne Contact for Permit
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<br /> Owner's Name 1 2 O /Y CC 1 6 Owner's Phone Number
<br /> Owner's Address V 3 3 D 2 id s% .- 2 6--7°y/Y /t (J r - ( 3? s V .
<br /> 7
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> 1L=1 (Semi) Other
<br /> Sprinkler a ):1 ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I I 1 Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 n Sprinkler System Installations
<br /> Hood Suppression 0 ❑ ❑ ❑ 1 1 n Standpipes (Sprinkler Sys)
<br /> I - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> I I Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> I I Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
<br /> Contractor Company I
<br /> Signature kd�3Y �' ( E a�frl��'n) Registered Y / N _ Fee Current I Y / N
<br /> Address I I License # I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current 1 Y/ N I
<br /> Address ( I License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N �I Fee Current L Y/ N 1
<br /> Address I
<br /> 1 License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address I I License # I I
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address J I
<br /> 'usua
<br /> l License # '' eury
<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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