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813 - 780 -0020 City of Zephyrhills Fire 'It /19(( Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received 1 Phone Contact for tact Permit J J
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<br /> Owner's Name 5', t d ' 14 (iji.Jf j t e_ Owner's Phone Number ?Sir 12Z-3
<br /> Owner's Address 3 6 g41 C 1 (..) rJIA.p - e L r 3 j Z
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
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<br /> ,��° ,:'mot �.t, "- r. � x .,.•,...
<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> T Comm Exhaust Kitchen Hood /Duct In 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 /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Q< Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> ILItrlyl ISemI fi j Other
<br /> Sprinkler n ❑ ❑ ❑ I I Recreational Burn
<br /> Fire Alarm n ❑ ❑ ❑ I 1 1 1 Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ ( 1 1 1 Sprinkler System Installations
<br /> Hood Suppression E ❑ ❑ , ( I l I Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> R Fire Pumps I I Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application- ANNUAL ( Valuation of Project
<br /> Fuel Tanks
<br /> I I Other: I
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<br /> Contractor _�� / Company f CrG ,9I At,... z a
<br /> Signature Registered Y / N Fee Current I Y / N
<br /> Address I I License #
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N j
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N _I Fee Current 1 Y/ N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address j License # I
<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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