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813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021
<br /> Permit Application
<br /> Date Received I /a -3v D fi Phone Contact for Permit
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<br /> Owner's Name G'/ / 5 I Z(1_ t -3 r Owner's Phone Number
<br /> Owner's Address - 5 7? 1 5 ! -s 71-1t , 4 "- ze - T ne
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
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<br /> Job Address 7R/ / c J - 4- _ �/l - Lot #
<br /> Sub Division Parcel #
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<br /> 1 Bio -Hazard Waste Storage - ANNUAL I Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct Ti Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum I I Hood Installation
<br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> Iutnyl !Semi 1 Other
<br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum /� O
<br /> _ .._ ... _ _ - - - - ! Fire Alarm n ❑ ❑ ❑ 1 1 I 1 Sparklers I g
<br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations
<br /> Hood Suppression Z ❑ /"( ❑ I 1 n Standpipes (Sprinkler Sys)
<br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps ( I Waste Tire Storage ANNUAL
<br /> 1 1 Fire Works
<br /> H Flammable Application- ANNUAL ( Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I I
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<br /> Contractor V I Company QA , iA - {Z IZ1: '
<br /> Signature / ° Registered Y / N 0 I Fee Current l I Y / N i
<br /> Address Ii ( License # I I
<br /> ELECTRICIAN Company I
<br /> Signature Registered L Y/ N I Fee Current I Y / N I
<br /> Address I 1 License # I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N Fee Current I Y/ N
<br /> Address I I License # I
<br /> MECHANICAL Company l
<br /> Signature Registered Y / N 1 Fee Current I Y / N I
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N 1
<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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