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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021
<br /> Permit Application
<br /> Date Received 1 /-- fi l Cf Phone Contact for Permit I I I I
<br /> Owner's Name •a /er S L c& frtli"'T&"+L — 2-eft' rem C-L; Owner's Phone Number I I
<br /> Owner's Address 1 3 347 Zo 7 77
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple - Titleholder Address -1 . — - J I
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<br /> Job Address V "13 Ta Z-D 77- )77Zc =C 1 Lot #
<br /> Sub Division Parcel #
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<br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> F Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> FT Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> lCttrly) jsemil I^i" I Other
<br /> Sprinkler n ❑ ❑ n Recreational Burn
<br /> Fire Alarm n ❑ ❑ ✓ 1 1 n Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ 1 1 I I Sprinkler System Installations
<br /> Hood Suppression n ❑ ❑ I: I I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> El Fire Pumps n Waste Tire Storage ANNUAL
<br /> I 1 Fire Works
<br /> n Flammable Application- ANNUAL 1 I Valuation of Project
<br /> n Fuel Tanks
<br /> I I Other: I I
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<br /> Company 1 AZLq�
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<br /> i /e& erc=crrav I
<br /> Signature 1' Reg Y/ N I Fee Current I Y/ N I
<br /> Address 1 if i z_ C'¢L, -r A, L. 1. C.r.,.. , vo, / L, JL7,5---t, 1 License # ( I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<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 1 Y / N - I
<br /> Address I I License # I I
<br /> OTHER Company I
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address I
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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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