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813 - 780 -002`u City of Zephyrhills Fire Fax- 813 -780 -0021
<br /> Permit Application
<br /> Date Received 1 1
<br /> Phone Contact for Permit
<br /> , .� W �7 " e
<br /> a Owner's Name � S/ rit �U/l C4 v/, 21 S / ---- Owner's Phone Number 1� 1 ,G
<br /> A/Owner's Address 3 T1 7 C 46- t/ /d -
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<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 I I 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 /> Ti Emergency Generator > 30 kw ' ► - r, - - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL . IN Places of Assembly - ANNUAL
<br /> IUtrlyl 1SemiI � Other
<br /> Sprinkler n ❑ ❑ ❑ Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I 1 n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 n Sprinkler System Installations
<br /> Hood Suppression D ❑ ❑ ❑ I n Standpipes (Sprinkler Sys)
<br /> I - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> El Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
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<br /> Contractor / Company
<br /> Signature -- ? c /a Registered Y / N I Fee Current I Y / N J
<br /> Address I I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N j Fee Current I Y/ N
<br /> Address I I License # I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y / N I
<br /> Address ( I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y / N j Fee Current I Y/ N I
<br /> Address ( I License #
<br /> OTHER Company
<br /> Signature Registered Y/ N J Fee Current I Y/ N I
<br /> Address I I License #
<br /> ate. -
<br /> �.w �__,�
<br /> Directions:
<br /> Fit 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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