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<br /> City of Zephyrhills Fire "
<br /> 813 780 -0020 tY h p Y CC, i I ` 3 ( P/ � Fax- 813 - 780 0021
<br /> Permit Application fi
<br /> I Phone Contact for Permit 1 352 11 318 14033 I
<br /> Date Received �. •,,, . a�; r �a�r, srre�. s... �:;, �rs� .�rrc,i.,�. >.suta- .:� .:.,_ .:...... ........:.w.. .:- ....- ..�.._....
<br /> Owner's Name St Joseph's Catholic Church Owner's Phone Number 813 782 2813
<br /> Owners Address 5316 11th St Zephyrhills Fl 33540
<br /> Fee Simple Titleholder Name same Titleholder Phone Number
<br /> Fee Simple Titleholder Address
<br /> - P ' * :;x ,3M ^sy. -f +_'Gt. -, rC R..,, , er. ,i1dr;= F V'MMMIT x;,.' , z a W ,r.. s .,...w Atu"c.:ailiz :' ;.
<br /> Job Address Church Hall 16185 5th Ave Zephyrhills F1 Lot#
<br /> Sub Division Parcel #
<br /> n a K:rom 9 z41:i ^x+'kdrerz, Ai 3. - -.,.., u.,,,- .:x;.,,,o,., . ....,r -- -x..r - :'ste= =altis.:',1E44. u;S -wsw.. 4f. ea.;.vRitokt ,..,,,=:r241 A,u- . ...:.:. .
<br /> 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 /> F - 7 Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> I -1 Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> !Unity' Isemil 1""' i Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm r ❑ ❑ I I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression 0 ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys)
<br /> © Fire Alarrn Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> Flammable Application- ANNUAL I $1185.00 I Valuation of Project
<br /> n Fuel Tanks
<br /> Other: I R- • el -y 7 t. ' , j E' x, -c 7 % n TP10 r ,-.g ).-_ 'f'-.) Q4 Zv •i
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<br /> ..s. «.kc,..,. irkzi?i �c:�� .,a�&sW. ;'��r='?'�.i� wS'w'u "'�-'. k.via`Sr.t .
<br /> �SS vs�f" nP. L. s'""' u7WAr°,.-.:: si=i' d' 8. m' 6se�w';:€. F#>' F.,: s`=" zett'.°.' dd=al:>: 3$. 1. a , k:. , .. ....
<br /> Contractor °C‘.-- Company Ru ell l e c t r i al o n s t LL
<br /> Signature - c� a R Registered 1E��� Fee Current L�
<br /> Address 1 4122 Thomas Boat Lnd Rd Umatilla Ft License# I EC 0002542
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N 1 Fee Current I Y / N
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature " ; I Registered Y / N I Fee Current Y / N
<br /> Address I "' ' _.
<br /> -'I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N I Fee Current I Y/ N
<br /> Address 1 License # I
<br /> OTHER Company
<br /> Signature Registered Y / N I Fee Current 1 Y / N
<br /> Address I I `: 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. SCfaiv c - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)
<br /> u bta
<br /> 1 hD PL • N(S) HAVE BEEN REVIEWED
<br /> BY ZEPH ' ' , p ' MARSHAL'S OFFICE
<br /> Date: t
<br /> Reviewer: 1 1' _ Pr
<br /> y
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