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<br /> 813= City of Zephyrhills Fire. Fax-813-780-0021
<br /> Permit Application
<br /> Date Received - - Phone Contact for Permit
<br /> Owner's Name S Till PT,F,XGR TNNELL Owner's Phone Number 813 626 15482
<br /> Owner's Address 4701 Oak Fair Blvd TAMPA FL 33610
<br /> Fee Simple Titleholder Name I . Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
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<br /> Job Address 5a5S "Dat.6111V-e (`k ( ?---octA- - .2. e. 9 lot{ 1-, , iis 'L 5354i Lot*
<br /> Sub Division Parcel #
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<br /> I ' Bio-Hazard Waste Storage - ANNUAL 1 I Fumigation Tent
<br /> I Comm Exhaust Kitchen Hood/Duct 1 1 Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> 1 . 1 Controlled Bum 1 1 Hood Installation
<br /> • 1 Emergency < 30 kw 1 1 LP/Natural Gas-Installation
<br /> _ , 1 1 Emergency Generator > 30 kw I 1 LP/Natural Gas-ANNUAL Safe
<br /> I. . Fire Protection Maintenance - ANNUAL • 1 1 Places of Assembly-ANNUAL • • p ilLgrlyi 'Semi! IAN! Other
<br /> • Sprinkler ar'' 0 o - 1 1 Recreational Bum
<br /> • , Fire Alarm 1 1 0 0 ID 1 , 1 1 1 Sparklers
<br /> • Hood Cleaning I I 0 0 0 1 1 1 I Sprinkler System Installations
<br /> • Hood Suppression 1 0 cl 01 1 1 1 Standpipes (Sprinkler Sys)
<br /> ._
<br /> .. . . I Fire Alarrn Installation 1 " 1 Torch Roofing/Tar Kettle - - - - -
<br /> . , . I Fire Pumps I • 1 . Waste Tire Storage ANNUAL
<br /> ' I Fire Works
<br /> Flammable Application- ANNUAL
<br /> 1 1 Valuation of Project
<br /> Fuel Tanks
<br /> ' • I Other I
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<br /> Contractor ' ir die
<br /> Company •-• cvrie te-,KSn-V.-f_.
<br /> • t (
<br /> Signature ' Registered Y / N I Fee Current I • Y / N 1
<br /> Address ,. . , I ,. License # .
<br /> ELECTRICIAN Company
<br /> Signature - • ' ' Registered Y / N _I Fee Current I Y / N
<br /> Address I . , • I License #
<br /> PLUMBER
<br /> '
<br /> Signature Registered Y / N 'I Fee Current I Y / N 1
<br /> Address 1 - .
<br /> 1 License # - ' I
<br /> MECHANICAL • • Company
<br /> Signature Registered Y/N I Fee Current 1 Y/N j •
<br /> Address 1. • 1 License # I
<br /> OTHER . - Company • - .
<br /> Signature Registered Y / N j Fee Current I Y / N I
<br /> Address License #
<br /> 1
<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 /> -
<br /> - Sdrawings upply two (2) sets of d 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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