Laserfiche WebLink
813-780-0020 City of Zephyrhills Fire <br /> " I I i 6 , Q� 1 Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received RWLYZe Phone Contact for Permit i r'W_I. <br /> .. IrMIZI <br /> Owner's Name /M4P/4 .e.J y ,efAst r�' ! / y /a (z� R 'y I 1- Owner's Phone Number I 1 75•2_ 75•2_ 177 ?c) <br /> Owner's Address T <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> XtIOMMEEIMISL . . x .. « : ? #Ea =4;° ' .: °x $''' �S - ''.«,; ,rte 8 -t--":, . e ., v r. - 4, ??"sd :., a ,„ ', N <br /> Job Address S o3 1 / IT 5`7" 2(4 Lot # <br /> Sub Division Parcel # <br /> _ � �G'.... �,` �. e» &Y + °s�€�.� sr.::..:. �- asys.;�.e-.�.tt;az;. � .. ,. .. ' "�.•uGar'•"ati :. .:<: <br /> n Bio- Hazard Waste Storage - ANNUAL n 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 /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> � 1-1 (any) ISemil 03 Uther <br /> Sprinkler ❑ ❑ ❑ I 1 Recreational Bum <br /> g l-s. <br /> Fire Alarm n ❑ ❑ ❑ 1 1 n Sparklers 114114 <br /> Hood Cleaning ('� ❑ ❑ ❑ ' ^( C <br /> � <br /> I I ( I n Sprinkler System Installations 0 el <br /> Hood Suppression ICI ❑ ❑ ›il I I n Standpipes (Sprinkler Sys) r <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps In Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I / 5-1.) I Valuation of Project <br /> n Fuel Tanks <br /> 0 Other: I <br /> Contractor Com an <br /> � ` <br /> �� %��� <br /> Signature Company F tea:S' �i rent I Y i N • �� <br /> � � � • Registered Y/ N I e Current � Y/ N <br /> Address '0 - a1„ 4 ,41,Ard!rff I t . y License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N j Fee Current I Y / N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I License # <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 />