|
813-780-0020 City of ZephyrhillsFire• Fax -813 -780 -0021
<br /> Permit Application
<br /> i 0 Phone Contact for Permit
<br /> Date Received I J � / I ..._ sar �..,..��:x.��a� , w�
<br /> Owners Name Z LP HAY �.Z (1 c,2 / Owner's Phone Number
<br /> Owner's Address tON ir 6A L L 4 L it 2 6- P ( Z c f ,z
<br /> Fee Simple Titleholder Name Titleholder Phone Number ,
<br /> •
<br /> Fee Simple Titleholder Address
<br /> _ , ". a iP. a z« ...,,, a; 'r�..,. 171fitr." • R';.w *a r °.:1` NNUMSc .;"`; « a : <r',...k._..a...,. t" ., ,...w. .«,..,......... ,......
<br /> Job Address v o (i2 CM L (0 Lot#
<br /> Sub Division Parcel U T >,. Mw«, x.,<,si�av arw«w, «, X, a�,r;.
<br /> arce
<br /> ' a.., ,,.,>M.T..;, �..' `: e..«�::.:.,. M_..:.�s.�;Ya�«�. a'. ��s.ax . . a. �e, m . a. •c .:. wm:�; .' <- r... s'.r:? _ e » .h.'�.,�'.i'" . � "�G�.ak.�...'. =_.. ._,.� m.. e, .... »�...
<br /> I I Bio- Hazard Waste Storage - ANNUAL I Fumigation Tent
<br /> I I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> - Controlled Burn 1 Hood installation
<br /> 7 Emergency Generator < 30 kw I LP /Natural Gas - Installation
<br /> 1 I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> I I Fire Protection Maintenance - ANNUAL 1 I Places of Assembly- ANNUAL
<br /> MO 'semi' ] Other
<br /> Sprinkler FZ1 ❑ ❑ 1 1 + I7d I I Recreational Bum
<br /> Fire Alarm ❑ ❑ ❑ I 1 I Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I 1 1 I Sprinkler System Installations
<br /> Hood Suppression I 1 ❑ ❑ ❑ 1 I 1 I Standpipes (Sprinkler Sys)
<br /> Fire Alarm Installation I Torch Roofing/Tar Kettle
<br /> I I Fire Pumps 1 I Waste Tire Storage ANNUAL
<br /> FT Fire Works
<br /> Flammable Application- ANNUAL Valuation of Project
<br /> Fuel Tanks
<br /> I Other: I c. ..tt..x.�,�.
<br /> ....._. .,.w..�:x 1.:« wry ; >«,.....s....;..,?'xr'.�u�e, �_.x. 's , gym ac.; _. .,. �:, u,:a�' -„ z[ ..«.. �. . , ,:,,,,,,I;;;,.:.,,,,,,.. x - , M.`..�.,r.�s�.€'�,.mriN,*.sx «. . _ ..M..
<br /> Contractor Company
<br /> Signature Registered Y / N I Fee Current I Y / N
<br /> Address 1 _ I License # I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y / N Fee Current I Y / N j
<br /> Address I License #
<br /> PLUMBER Company
<br /> Signature Registered Y / N Fee Current 1 Y / N
<br /> Address License #
<br /> MECHANICAL Company
<br /> Signature Registered Y / N Fee Current L Y / N
<br /> Address I License #
<br /> OTHER Company
<br /> Signature Registered Y / N Fee Current 1 Y / N I
<br /> Address I License #
<br /> �, ., a «.�...,...:
<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 />
|