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813-780-0020 City of Zephyrhills Fire Fax- 813-780 -0021
<br /> Permit Application
<br /> Date Received
<br /> Phone Contact for Permit I
<br /> Owner's Name C AsZn a C; Vy " .1Y C. t K , f„ Owner's Phone Number 1 I I I ft
<br /> Owner's Address % ')r) (� � , .4� o a 1 2e{ 1 Ffrovt- S -3 J .L�._
<br /> Fee Simple Titleholder Name III Titleholder Phone Number
<br /> Fee Simple Titleholder Address
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<br /> �RtMe Mi � ra g &r,, .'� .. , w , w ... r iNio m , ,ek, . zt,. a a :
<br /> Job Address
<br /> Lot #
<br /> Sub Division Parcel #
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<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 n Hood Installation
<br /> n 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 114 Places of Assembly- ANNUAL
<br /> r y 'Semi ( WA Other
<br /> Sprinkler ❑ ❑ ❑ I Recreational Bum
<br /> Fire Alarm ( Sparklers
<br /> ❑ ❑ ❑ I I I
<br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations
<br /> Hood Suppression D ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps I Waste Tire Storage ANNUAL
<br /> I Fire Works
<br /> El Flammable Application- ANNUAL I I Valuation of Project
<br /> n Fuel Tanks
<br /> n Other: I I
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<br /> Contractor Company
<br /> Signature ),.41 40 V Registered Y/ N Fee Current 1 Y / N I
<br /> Address I License # I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N J Fee Current I Y / N j
<br /> Address I I License # I I
<br /> PLUMBER Company
<br /> Signature Registered Y/ N I Fee Current I Y / N j
<br /> Address I I License # I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N j Fee Current I Y / N I
<br /> Address 1
<br /> 1 License # I I
<br /> OTHER Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address License #
<br /> 1
<br /> Directions:
<br /> ns::: .._. .::
<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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