|
813- 780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021
<br /> Permit Application
<br /> Date Received 1 1 Phone Contact for Permit I 1 1
<br /> :ice. .... ..,•. ... ..,. :... ,,._. . a,,..:,, ,n,. ,.•s«+ ,_.a,� � °� ,_i ;xaF ..s >.. .. �.. :;�, , .. ,+.z .:: � ,, . s ��... .....;�.. ...w<, , ,., « . ..
<br /> Owner's Name 19 .. /91)AgJ04 Alflrn ,yOwner's Phone Number ./3 2Y-3 180 %9
<br /> Owner's Address . 0 / 7 ',4-- /1 tic .2 el A7 h; � /. 97 33_5 v
<br /> Fee Simple Titleholder Name ____._- -- Titleholder Phone Number
<br /> Fee Simple Titleholder Address J
<br /> . ;r - l a 'c` ,,, ....., , V . 1511,, 4r.... MO 7 ,� :" .m::Y:'ss..4 , , ; _ r : Z ` .RM i, . :a' n"'rg',��s z ' SaTM - i .. " F / .., M .�.., n €; _.
<br /> Job Address
<br /> / ,' // � �J�j!/ /.,si o< ��Aris /// �. -5 T o t#
<br /> y v /
<br /> Sub Division Parcel #
<br /> B..n.a,. ..x. :.:n t _.43,. 5. «::. t', v , jp ,, 3 w ,at,"3 G 's...- o. s:x , aw. a,'Ya,,m0 ... k,.4 e :. -*v'^', €t z:: ;z: R .,, a,a .,..... z44: - -,._ .. . .,etzk:...: mN,.,, . .._t - ..,.. ...
<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> F - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> ' Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> !Lally' 1Semi ) LW Uther
<br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ 1 1 1 Standpipes (Sprinkler Sys)
<br /> F - 1 Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps Ti Waste Tire Storage ANNUAL
<br /> E] Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> El Other: 1
<br /> ,.._.A. . .Y" _:.t611Z::.;IAUM£t.s'," €..:..' s.7' <k:Y,<F z`ilgV . .t" : ° Z3 .w LZAD s E,',INaiiV.rya.Q<:; r.:.J., rc.cs .._." iMk.∎: w..x. ....,s.T4'8•::IgoWeg?9ga
<br /> Contractor Company � - 7,9--j i `A j /1/, `r)
<br /> Signature i ��G 7 C.i,r— Registered Y N Fee Current a// N
<br /> Address 1 I License # ( 1
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N 1 Fee Current 1 Y / N
<br /> Address I 1 License #
<br /> PLUMBER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N 1
<br /> Address I I License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N J Fee Current 1 Y / N 1
<br /> Address I I License # J
<br /> OTHER Company
<br /> Signature Registered Y/ N J Fee Current I Y/ N
<br /> Address 1 1 License* 1
<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)
<br />
|