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813 - 780 -0020 City of Zephyrhills Fire qq2A Fax -813- 780 -0021 ,tf Permit Application
<br /> Date Received ) / /i1 /�/,0 J 1 Phone Contact for Permit 35 1 J 5 1 J 5 1
<br /> 111 . EE, .
<br /> Owner's Name A tf!-1-5 (� Owner's Phone Number 1
<br /> Owner's Address 1/g22. 6 4_ 6/ / ///V4 z e , y -X, 115 ,
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I
<br /> z ',1z .; .. 4f, > m m, P15, M t .,rc R Z'M &t,h., tworm om r <Koffrs - +'I ,+....aa ,. , , 01 �_ ,. ,,, / .. ' l € _ _ . ,. ILA& ».,. . , ;.,::-.r. M ., :,
<br /> Job Address L /82-2- 6 // 4 //'G( Z C �j )j/�, l l s / — Lot #
<br /> Sub Division I Parcel #
<br /> ,� .,, ... ...... ,; ..��1 .,.,._ ;,. ;1A , e:Ar„ «;W4V.XM, ea t. +r,,,a .,16WA MERE .fir.., ..:fea ... ,. P ,M,. ,VaZ. n., K f; _ E a,�..�. , Ja..z; , ,. W; , ,Mai; ;2,, ,,
<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> I I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum I I Hood Installation
<br /> 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 I I Places of Assembly- ANNUAL
<br /> IQtrly' 'Semi' rAITI Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ ( I n Sparklers
<br /> Hood Cleaning E ❑ ❑ ❑ I 1 n Sprinkler System Installations
<br /> ry Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps I I Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> Other
<br /> Contractor (' Company 55peC l f f' /,� lr- el-u, L S(� 5
<br /> °`
<br /> Signature -7 / Registered Y / N 1 Fee Current I Y/ N j /
<br /> Address L 7 7 ? /9 �cc C r / 4, z / Z ,4- D1 ('r A I License # I &-F. UU , 0/fJ y(4 I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N 1
<br /> Address I I License #
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # I
<br /> MECHANICAL Company I
<br /> Signature Registered Y / N I Fee Current I Y / N j
<br /> Address 1 I License # I
<br /> OTHER Company I
<br /> Signature Registered Y/ N I Fee Current I Y / N 1
<br /> Address I I License # J
<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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