Laserfiche WebLink
813-780 -0020 City of Zephyrhills Fire <br /> Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received <br /> i <br /> Phone Contact for Permit <br /> . ..vr <br /> Owner's Name rn C - 6 )41- ' S Owner's Phone Number 1 1 1 I I I <br /> Owner's Address 1 - 6042_ & (4LL B { ) . Zi _ lJI- I � f )1t R L S /CC - 3 3 5 - 4 1 I <br /> Fee Simple Titleholder Name I N �+`�/ �f <br /> I Titleholder Phone Number I 1 1 I I I <br /> Fee Simple Titleholder Address I <br /> Job Address <br /> Lot # I f l <br /> Sub Division I I Parcel # <br /> .: ? W :ii . .,. saws �,, kg _ awls �. n � =ii,, . . <br /> ,m E3 , .., ,., . <br /> Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct ( I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> IT Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL In Places of Assembly- ANNUAL <br /> ❑ 1c.ttrlyj Semi) WA rher <br /> Sprinkler ❑ ID ID I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 J n Sparklers <br /> Hood Cleaning 7 ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys) <br /> n FT Fire Alarm Installation I ( Torch Roofing/Tar Kettle <br /> Fire Pumps I ( Waste Tire Storage ANNUAL <br /> ( 1 Fire Works <br /> ( Flammable Application- ANNUAL I I <br /> n Valuation of Project <br /> Fuel Tanks <br /> n Other: <br /> a ..w ..; mss <br /> 11W41111,111r1rAlir / es. .:.: Contractor <br /> Company <br /> Signature —" ----/ Registered Y / N . 1 Fee Current I Y / N , <br /> Address Orr License # <br /> ELECTRICIAN I Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I <br /> 1 1 <br /> License # <br /> PLUMBER I I Company <br /> Signature Registered Y/ N J Fee Current I Y / N, <br /> Address I ( <br /> License # <br /> MECHANICAL I Company <br /> Signature Registered Y / N J Fee Current I Y / NJ <br /> Address I I <br /> License # <br /> OTHER I I Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N j <br /> Address 1 License # <br /> . >: »...;ate ,E ::w Wes,€ ,».?. <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) <br />