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813-780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
<br /> Permit Application _
<br /> Date Received l i) 6C 3 Z (-O I Phone Contact for Permit
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<br /> 1
<br /> Owner's Name I S.l 4CO C-l LEPer, oU`S` Y Skop Owner's Phone Number p13 -72,s I jZ2S
<br /> Owner's Address 3684 ( CLAD kc u S . .brit)
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address 1
<br /> Job Address Lot#
<br /> Sub Division Parcel #
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<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 /> I-1 Controlled Bum n Hood Installation
<br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL rv i Places of Assembly- ANNUAL
<br /> rt:ffTyl ISerni ) (A Other -
<br /> Sprinkler Ei ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I ( I I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression D ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation 1 1 Torch Roofing/Tar Kettle
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> I Fire Works
<br /> H Flammable Application- ANNUAL I I Valuation of Project
<br /> Fuel Tanks
<br /> I—I Other: I
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<br /> Contractor Company I
<br /> C t Q Y
<br /> Signature , " Registered Y/ N . 1 Fee Current I Y/ N I
<br /> Address I I License #
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N 1
<br /> Address I I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N I Fee Current I Y / N I
<br /> Address I
<br /> 1 License #
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N Fee Current I Y / N I
<br /> Address ( I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address 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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