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813-780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Rebeived (1 1(4 (4 0 Phone Contact for Permit I
<br /> 111 r
<br /> Owner's Name r; Lk � 16_, yt Owner's Phone Number
<br /> Owner's Address 5 I L CIA i t. 6 i .J d t v ti k, izJitt is Fc_ ' 54 /
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
<br /> '•,, H .?. „.. . p . ..,,,.. v.. q`i. -i., s 3` .-.i W, Wit,. "m. ,.,,,„ , : , r . GI.�•..�,, ,, , m ' e ,..,. k3^, "x. _ . . ..i ., A....,_. , . . . . ,,x.�. •
<br /> ... _ , .. £- Grp
<br /> Job Address Lot #
<br /> Sub Division Parcel #
<br /> E � a a� ; a _., . p..,,, g :=:.. a m. azw �m� . , ...,. , F . . ,s . _. ... .. . , . . a .�
<br /> n Bio- Hazard Waste Storage - � -
<br /> rage � - 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 /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> I 1 Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Ti Fire Protection Maintenance - ANNUAL I\,, Places of Assembly- ANNUAL
<br /> 1Utrl 1 berm l MA Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Burn
<br /> Fire Alarm 1 ❑ ❑ ❑ I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ ( I Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ i 1 n Standpipes (Sprinkler Sys)
<br /> I Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> Flammable Application- ANNUAL
<br /> 1 ( Valuation of Project
<br /> �;1 '
<br /> Fuel Tanks
<br /> n Other: I
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<br /> Contractor Company
<br /> Signature ' —` Registered Y/ N I Fee Current I Y/ N I
<br /> Address 1 I License #
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N j Fee Current 1 Y/ N
<br /> Address 1
<br /> 1 License #
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current Y / N J
<br /> Address I
<br /> 1 License
<br /> #
<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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