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813 -780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received
<br /> 1 Phone Contact for Permit
<br /> Owner's Name QC LJA CLEF Ni tiG ,, 12-- V(C.C� I kIC , Owner's Phone Number I I
<br /> Owner's Address
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address me bP'JAC_IJ S 76 .6' , 6A C.C. I)Li4L , Lot#
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL r---1 Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> El Controlled Bum n Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL Ti Places of Assembly- ANNUAL
<br /> IUtrly "Semi' Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I 1 1 Sparklers
<br /> Hood Cleaning I> i ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> 1 Fire Pumps n Waste Tire Storage ANNUAL
<br /> I [ ] Fire Works
<br /> Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
<br /> Company M..../VA J e -K-Cy/ L_ C� I
<br /> Si Registered Y / N j Fee Current 1 Y/ N 4
<br /> Address I
<br /> 1 License #
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N
<br /> Address 1 I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N 1
<br /> Address
<br /> I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N 1 Fee Current I Y / N I
<br /> Address 1
<br /> I License #
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N I
<br /> Address I
<br /> 1 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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