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813-780-0020 City of Zephyrhills Fire. � q 2 ( t Fax- 813 -780 -0021
<br /> Permit Application
<br /> Date Received WRY 0' Phone Contact fo 813 111,33 1. 9 Q /
<br /> Owner's Name SI m4 f)( b/1r)JP Owner's Phone Number
<br /> Owner (,
<br /> Owner's Address 4 1701 r ©A k Pt:, E luel, 7 C m Y m u , FL 3 3 ( ) 0
<br /> Fee Simple Titleholder Name Titleholder Phone Number
<br /> Fee Simple Titleholder Address
<br /> i:& txk w.,,, ,,,,,-*.: -;-, 4 a . 3 , ..-,, ,,, ,c., '. --,,•• .. -' z-•i z ' -,..,:,--,•• r.,, :t � =.: f , .".•--�' is' Y's ,1: 4, ,,,, e - .'0 , --= a.' e'+ br:n '•as:�z, -a _qw, ..i: :' , g
<br /> Job Address lo 1 1 _l 6a11 gJ d, L J h c I r h 11)s / F"G. 3 35j/ / Lot#
<br /> Sub Division ! Parcel #
<br /> I Bio- Hazard Waste Storage - ANNUAL I 1 Fumigation Tent
<br /> n Comm Exhaust Kitchen Hood /Duct I] Hazardous Material (Tier II or RQ Facility) ANNUAL
<br /> I I Controlled Bum I I Hood Installation
<br /> I7 Emergency Generator < 30 kw I I LP /Natural Gas - Installation
<br /> h Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale
<br /> I I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL
<br /> Lag I Semi, 177111 Other "
<br /> Sprinkler la L. ❑ ❑ I I Recreational Burn
<br /> Fire Alarm I 1 0 ❑ ❑ I I I I Sparklers
<br /> Hood Cleaning I ❑ ❑ ❑ 1 I 1 1 Sprinkler System Installations
<br /> Hood Suppression 1 ❑ ❑ ❑ I 1 I I Standpipes (Sprinkler Sys)
<br /> I I Fire Alarm Installation 1 1 Torch Roofing/Tar Kettle
<br /> I Fire Pumps I I Waste Tire Storage ANNUAL
<br /> I I Fire Works
<br /> i Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> Ii Fuel Tanks
<br /> 1 Other: 1
<br /> IffEREMENr
<br /> /l ,
<br /> Contractor "
<br /> Company . Cyr - t
<br /> Signature Registered Y / N Fee Current Y / N
<br /> Address I s
<br /> I License # I I
<br /> ELECTRICIAN Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I I License # I I
<br /> PLUMBER Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> MECHANICAL Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N
<br /> Address I I License # I
<br /> OTHER Company
<br /> Signature Registered Y/ N 1 Fee Current I Y/ N I
<br /> Address License #
<br /> .�. �.._
<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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