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813 -780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received Phone Contact for Permit I I l
<br /> Owner's Name r 766^ 1" a, 01./CILLO" A Owner's Phone Number
<br /> < Owner's Address ( p 0 UJ D F S7`' l
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee SimpleTitleholderAddress 1
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<br /> Job Address Lot #
<br /> Sub Division Parcel #
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<br /> Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum Hood Installation
<br /> El Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> El Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL ® Places of Assembly- ANNUAL
<br /> lUtrlyl ISemij FF Other
<br /> Sprinkler E ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I n Sparklers
<br /> Hood Cleaning I—I ❑ ❑ ❑ I 1 n Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ ❑ 1 I n Standpipes (Sprinkler Sys)
<br /> El Fire Alarm Installation Torch Roofing/Tar Kettle
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> Flammable Application- ANNUAL 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I
<br /> h>x?«r...+&'...«?,f,.• zu_..2feWil•• ....u•. , ENEMrkeIUMEO M €4$ i° MMffi ;ul "` t. " i" '> ,:.€'v KI...e.wE. €-:a a Aa..a•. M d <.k....aa.: , ........>,7.Maeaa: �.Kalt . ..a>..:: '.5s_.NGar°a..:iE5;:.
<br /> Contractor � ` / Company
<br /> Signature � .. / :// _ IIIP �. I�ri..L�. Registered Y / N j Fee Current I Y / N I
<br /> Address I ( License # I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N I Fee Current I Y/ N I
<br /> Address I 1 License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N ] Fee Current I Y / N J
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y / N
<br /> Address I License #
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N
<br /> Address I License # I 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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