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813 -780 -0020 City of Zephyrhills Fire / ,3 Fax -813- 780 -0021
<br /> _ Permit Application
<br /> Date Received r Phone Contact for Permit
<br /> Owner's Name f /i/ rj 6 a fdde- t5 Owner's Phone Number 788 4/5V6
<br /> Owner's Address _fS-/ 4 6-e // /i/.1 3 ,Y55/ Z
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> Job Address ,J ll6 & Q l/ // /re Lot #
<br /> Sub Division Parcel #
<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 /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> El Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> EZ Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> r y 'Semi' 711 Other
<br /> Sprinkler El ❑ ❑ ❑ n Recreational Burn
<br /> Fire Alarm n ❑ ❑ ❑ 1 I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ 1 1 n Standpipes (Sprinkler Sys)
<br /> I I Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> I Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
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<br /> Contractor —T �- -- '�/'' Company Y / N ,so hi."-_
<br /> �" /' _ Registered Y / N J Fee Current I Y / N 1
<br /> Address I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y / N 1 Fee Current I Y / N 1
<br /> Address ( I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current I Y / N 1
<br /> Address I I License # I
<br /> OTHER Company I
<br /> Signature Registered Y / N I Fee Current I Y / N j
<br /> Address I I License #
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<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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