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813-780-0020 City of Zephyrhills Fire
<br /> Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received Phone Contact for Permit
<br /> Owner's Name I �j J Pt j f )5 / 4/61 Owner's Phone Number I I 1 11
<br /> Owner's Address 15 / - 7 7 s71 0e ,,., Yi4, D Ts F,[ 33 -4VA? I
<br /> Fee Simple Titleholder Name Titleholder Phone Number I 11 II
<br /> Fee Simple Titleholder Address
<br /> fit.,, , s , e ya.
<br /> Job Address I I
<br /> Lot #
<br /> Sub Division Parcel # I
<br /> 3:: _ ...:s . , .: «:u , ..m:,. ; _ . ,w..' , ,,, :' r- . F >:s:..:a:: 44aaa.-, Y��.uec "asp`w' .•i -a £;v MV:T U, eS,.a SnV:
<br /> - a.;..,w" OA,;....: .fi. x...=, ,:,,,.�E,.Z ., rte... »•,» .W
<br /> Bio- Hazard Waste Storage - ANNUAL r Fumigation Tent "'
<br /> n 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 I >4 Places of Assembly - ANNUAL
<br /> (Utrlyl'SemiI LW Other
<br /> Sprinkler TI ❑ ❑ ❑ n Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ 1 I I Sparklers
<br /> Hood Cleaning 7 ❑ ❑ ❑ I l n Sprinkler System Installations
<br /> Hood Suppression ❑ ❑ ❑ I l n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps I Waste Tire Storage ANNUAL
<br /> El Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 n Valuation of Project
<br /> Fuel Tanks
<br /> n Other: I
<br /> M1,a° ,...20,.VA .'€t"a.nK,. .:^.,vA: SSG......`-` s.. l- w.,TZMia�2" cSa.. �a .,.�sf•'.w,-MAa1:IEM.5z°.::..E02:1w 3 _.A.. .: sa..0 a .0
<br /> .: .. ;Wa:°"aM_saet,.. s,x1?,ItA Pa... f..,:, .fwE,..._°s,.AYZu.:•': • Contractor � L //! j I Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N J
<br /> Address I
<br /> 1 License #
<br /> ELECTRICIAN' Company
<br /> Signature I Registered Y / N _I Fee Current I Y / N
<br /> Address I I License # I
<br /> PLUMBER I Company I
<br /> Signature Registered Y / N j Fee Current I Y / N
<br /> Address I
<br /> 1 License # I
<br /> MECHANICAL' Company
<br /> Signature Registered Y / N I Fee Current 1 Y/ N J
<br /> Address I
<br /> 1 License #
<br /> OTHER I I Company
<br /> Signature Registered Y/ N _I Fee Current I Y/ N j
<br /> Address I
<br /> a•N License #
<br /> .0 a.
<br /> Directions: w,.:
<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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